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Reference  ^Library 


NATURAL   HISTORY 


AND 


DISEASES 


OF    THE 


HUMAN    TEETH. 


J)r.  Q.  Evans, 
55  We#t  H'Mh  8L 
the         j$ew  York. 

NATURAL    HISTORY 

AND 

DISEASES 

OF 

THE    HUMAN    TEETH, 

BY 

JOSEPH    FOX,   M.  R.  C.  S.  L,, 

MEMBER   OF   THE    SOCIETY    OF   MEDICINE,   PARIS;    LECTURER   ON   THE    STRUCTURE    AND    DISEASES    OF   THE   TEETH, 

AT  guy's   hospital;   AND   SURGEON   DENTIST  TO  THEIR  ROYAL  HIGHNESSES 

THE    DUKES    OF   KENT   AND    SUSSEX. 

FIRST   AMERICAN  FROM  THE   THIRD  LONDON  EDITION. 

REMODELED,  WITH    AN    INTRODUCTION    AND    NUMEROUS    ADDITIONS,   BY 

CHAPIN   A.  HARRIS,  M.D.,  D.D.S., 

PROFESSOR     OF     PRACTICAL    DENTISTRY     AND     DENTAL     PATHOLOGY     IN     THE     BALTIMORE     COLLEGE     OF     DENTAL 

SURGERY  ;    FELLOW    OF    THE    AMERICAN    SOCIETY    OF    DENTAL    SURGEONS  ;    MEMBER    OF    THE 

MEDICO-CHIRURG1CAL    FACULTY    OF    MARYLAND  ;    AUTHOR    OF    PRINCIPLES 

AND    PRACTICE    OF    DENTAL    SURGERY,    ETC.    ETC. 

ILLUSTRATED  WITH   THIRTY   PLATES. 


PHILADELPHIA: 
ED.    BARRING  TON    AND    GEO.    D.    HAS  WELL. 

1846. 


iCAl   COLLECTION 


C  1 


Entered  according  to  act  of  Congress,  in  the  year  one  thousand  eight  hundred  and  forty-six, 

By  Ed.  Barrington  and  Geo.  D.  Haswell, 

In  the  Clerk's  Office  of  the  District  Court  of  the  Eastern  District  of  Pennsylvania. 


.I011N    D.    TOY,    PRINTER. 


TO 


HENRY    CLINE,   Esq. 

lecturer  on  anatomy,  and  surgeon  of  st.  thomas'  hospital. 

Dear  Sir: 

The  numerous  and  continued  marks  of  friendship 
and  attention  which  I  have  received  from  you,  demand 
my  most  grateful  acknowledgments. 

When  at  a  very  early  age  I  was  deprived  of  my  father, 
you  kindly  stepped  forward  with  your  advice,  and,  by 
your  countenance,  and  the  sanction  of  your  name,  trans- 
ferred to  me  the  confidence  of  his  friends,  and  secured 
the  continuance  of  a  respectable  practice. 

To  the  knowledge  I  obtained  from  you  when  your 
pupil,  and  the  opportunities  of  information  I  have  since 
derived  from  the  easy  access  with  which  you  have  always 
favoured  me,  I  attribute,  in  a  very  considerable  degree, 
the  success  which  has  attended  my  practice  in  that 
particular  branch  of  the  profession  to  which  I  have 
applied. 
2 


VI  DEDICATION. 

Your  having  been  pleased  to  speak  favourably  respect- 
ing the  utility  of  the  present  Work,  is  a  great  encourage- 
ment to  me  in  submitting  it  to  the  Public;  and,  in 
permitting  me  to  inscribe  it  to  you,  I  feel  another  flattering 
mark  of  attention  conferred  on. 

Dear  Sir, 

Your  faithful  and  obedient  servant, 

Joseph  Fox. 

No.  54  Lombard  Street, 
April  20,  1803. 


PRE  FAC  E 

TO    THE    AMERICAN    EDITION 


The  first  complete  edition  of  this  Work  was  published 
in  1806;  and,  notwithstanding  the  rapid  progress  which 
Dental  Surgery  has  made  subsequently  to  that  period,  it 
still  occupies  a  high  place  in  the  literature  of  this  depart- 
ment of  medicine.  It  has  been  more  extensively  quoted 
than  any  other  Treatise  upon  the  same  subject,  and  has 
passed  through  three  editions  in  England.  The  last  of 
which  was  published  in  1833.  There  is  still,  both  in 
Europe  and  America,  a  steady  demand  for  it. 

The  Author,  during  his  professional  career,  enjoyed  a 
high  reputation  as  a  practitioner  of  Dental  Surgery;  and 
for  many  years  previously  to  his  death  was  a  lecturer  on 
this  branch  of  medicine  in  Guy's  Hospital.  Although  he 
has  passed  from  among  the  living,  he  has  left  behind  him 
a  memorial  which  will  perpetuate  his  name  to  the  latest 
period  of  time.  Wherever,  and  so  long,  as  this  branch 
of  Surgery  shall  be  practiced  by  educated  men,  will  the 
name  of  Fox  be  held  in  grateful  remembrance. 

In  preparing  the  work  for  republication  in  this  country, 
the  editor  has  found  it  necessary  to  make  numerous  and 


Vlii  PREFACE    TO    THE    AMERICAN    EDITION. 

extensive  additions,  in  order  to  adapt  it  to  the  present 
state  of  dental  practice.  These  are  designated  [by  brack- 
ets,] and  are  about  equal  to  three-fourths  of  the  original 
text.  He  has  also  added  seven  plates,  remodeled  the 
arrangement  of  the  subjects,  and  placed  over  each  an 
appropriate  caption. 

The  English  editions  are  divided  into  two  parts.  This 
has  three.  The  last  is  devoted  to  artificial  teeth,  obtura- 
tors and  palates,  and  with  the  exception  of  four  or  five 
pages,  consists  of  additions  furnished  by  the  editor. 

Although  it  has  been  deemed  necessary  to  change  the 
arrangement  of  some  of  the  subjects  of  the  Treatise,  the 
whole  of  the  original  text,  with  the  exception  of  some 
ten  or  twelve  pages,  will  be  found  in  the  present  edition 
of  the  work.  These  were  left  out,  because  they  related 
to  treatment  of  affections  of  the  teeth  which  at  present  is 
never  adopted. 

It  will  be  found  that  the  scope  of  the  work  has  not 
been  materially  enlarged — the  chief  aim  of  the  editor 
having  been,  to  supply  such  details  of  subsequent  im- 
provements in  practice,  as  the  present  state  of  the  science 
and  art  seemed  to  demand.  If  the  manner  in  which  he 
has  done  this  shall  prove  satisfactory  to  his  professional 
brethren,  his  object  will  have  been  accomplished,  and  he 
will  not  regret  having  consented  to  assume  the  task. 


CHAPIN    A.  HARRIS. 


Baltimore,  Md. 
Jan.  1,  1846. 


PREFACE 

TO    THE    THIRD    LONDON    EDITION. 

GtG  -o,  _ •• 

49  Wesi  byiii  oiM  w.  Y.  City,  uL<Jhu^    l.    mbj 

49  West  39th  St,  N.Y.  City, 

Since  the  appearance  of  the  Second  Edition  of  this 
work;  the  profession  have  lost  the  personal  services  of  its 
respected  Author;  but,  notwithstanding  twenty  years 
have  clasped  since  he  gave  his  last  attention  to  the  sub- 
ject, it  is  the  opinion  of  good  authorities  that  neither 
alterations  nor  additions  are  required. 

The  importance  of  duly  attending  to  the  diseases  of 
the  teeth,  and  the  motives  which  induced  the  Author  to 
publish,  cannot  be  better  explained  than  by  making  the 
following  reprint  of  his  own  preface. 

"  The  operations  of  the  living  functions  of  all  animal 
bodies  having  a  constant  tendency  to  consume  the  sub- 
stance of  which  the  general  frame  consists,  a  certain  and 
regular  prpvision  is  required  for  the  repairs  of  those  in- 
juries which  the  body  commits  upon  itself. 

"Abundant  supplies  for  the  production  of  new  cor- 
poreal matter  exist,  as  articles  of  food,  in  the  animal  and 
vegetable  kingdoms;  and,  by  a  bountiful  Providence,  are 
adapted   to  the  taste  and  instincts  of  all  his  creatures. 


X  PREFACE    TO    THE 

But  before  these  articles  of  food  can  become  nutriment 
for  the  body,  they  must  undergo  certain  processes.  The 
first  is,  that  whereby  it  is  broken  down  into  small  par- 
ticles, and,  being  mingled  with  the  fluids  of  the  mouth,  is 
comminuted  into  a  fine  mass,  and  prepared  for  the  action 
of  the  stomach,  in  the  process  of  digestion. 

"The  teeth  are  the  organs  provided  by  nature  for 
the  mastication  of  food,  which  is  an  operation  so  essen- 
tial to  health,  that  without  a  due  preparation  of  the 
aliments,  the  digestion  must  always  be  more  or  less 
deranged. 

"The  teeth  which  appear  in  the  early  part  of  life  are 
adapted  to  the  state  of  childhood;  and  at  a  certain  period 
are  succeeded  by  a  second  set,  which  are  designed  to 
continue  during  the  remainder  of  life. 

"'The  first,  or  temporary  set  of  teeth,  are  very  liable  to 
become  diseased;  and  in  the  majority  of  cases  they  do 
not  naturally  fall  out  in  sufficient  time  to  permit  the 
second,  or  permanent,  set  of  teeth  to  arrange  themselves 
in  their  proper  order. 

"A  knowledge  of  the  changes  which  the  teeth  un- 
dergo, is  a  very  interesting  part  of  natural  history,  and  is 
absolutely  requisite  to  enable  a  practitioner  in  surgery  to 
render  such  assistance  during  the  progress  of  the  second 
dentition,  as  may  preserve  the  permanent  teeth  from 
being  injured  by  the  diseases  of  the  temporary  teeth;  or, 
from  acquiring  that  irregularity  which  always  occasions 
so  much  deformity,  and  often  destroys  correct  pronun- 
ciation. 


THIRD    LONDON    EDITION.  xi 

"An  attention  to  the  appearance  of  the  teeth; — a  de- 
sire to  preserve  them  in  a  healthy  state; — and  the  neces- 
sity which  exists  of  procuring  relief  when  affected  by 
disease,  are  sources  of  considerable  occupation.  In  the 
metropolis  and  large  towns,  professional  men,  as  dentists, 
are  enabled  to  confine  their  practice  to  this  department 
alone;  but  in  those  situations  where  surgeons  are  obliged 
to  undertake  medicine  and  surgery  in  all  their  branches, 
it  is  very  necessary  that  they  should  be  as  well  acquainted 
with  the  structure  and  diseases  of  the  teeth,  as  of  any 
other  part  of  practice  whatsoever. 

"  Mr.  Hunter's  publication  on  the  teeth  was  the  first 
scientific  book  ever  published  upon  this  subject;  and,  as 
an  anatomical  work,  must  ever  enjoy  great  celebrity; 
but  not  having  practically  devoted  much  of  his  attention 
to  the  operations  upon  the  teeth,  there  can  be  no  re- 
flection upon  Mr.  Hunter's  merit  in  stating,  that  in  many 
essential  points  he  was  wholly,  but  unavoidably,  deficient ; 
particularly  in  regard  to  the  right  management  of  the 
teeth  during  the  second  dentition." 

Further  it  appears  that  during  the  time  the  Author 
was  engaged  as  a  dresser  with  Mr.  Cline,  he  found 
amongst  the  pupils  of  St.  Thomas'  and  Guy's  Hospitals  a 
great  desire  to  obtain  particular  information  concerning 
the  diseases  of  the  teeth.  Frequent  conversation  on 
these  subjects,  and  descriptions  of  the  modes  of  per- 
forming some  operations,  led  to  the  delivery  of  a  Course 
of  Lectures  on  the  Structure  and  Diseases  of  the  Teeth. 
In   this  undertaking,  much  assistance   was  rendered  by 


Xii        PREFACE    TO    THE    THIRD    LONDON    EDITION. 

Mr.  (now  Sir  Astley)  Cooper.  The  first  Course  was 
given  in  the  Spring  of  1799,  after  which  they  were  con- 
tinued as  one  of  the  Spring  Courses  of  Lectures  delivered 
at  Guy's  Hospital^  and  finally  gave  origin  to  the  present 
work. 


London, 
Oct.  15,  1833. 


CONTENTS. 

Introduction,      .         .         .         .         .  .         .         .         .21 

PART    FIRST. 

The  Natural  History  of  the  Formation  and  Structure 

of  the  Teeth,  &c.  &c, 27 

CHAPTER    FIRST. 
Of  the  Formation  of  the  Temporary  Teeth,      .         .         .29 

CHAPTER    SECOND. 
Of  the  Formation  of  the  Permanent  Teeth,  .         .         35 

CHAPTER    THIRD. 

Of  the  Manner  in  which  the  Teeth  are  Formed,     .         .  44 

Manner  of  the  formation  of  the  Enamel,       ....  52 

Arteries  of  the  Teeth, 59 

Nerves  of  the  Teeth, 60 

Absorbents  of  the  Teeth, 61 

Articulation  of  the  Teeth,             62 

Structure  of  the  Teeth,             ....                          .  ib. 

CHAPTER    FOURTH. 

Of  the  Shedding  of  the  Teeth,  .....         66 

3 


xiv  CONTENTS. 

CHAPTER    FIFTH. 

Of  the  Irregularity  of  the  Teeth, 7ti 

Accretion  of  the  Jaws, 78 

CHAPTER    SIXTH. 

Of  the  Treatment  to  Prevent  Irregularity  of  the  Teeth,  83 

CHAPTER    SEVENTH. 

Of  the  Treatment  to  Remedy  Irregularity  of  the  Teeth,  87 

CHAPTER    EIGHTH. 

Of  Supernumerary  Teeth, 103 

CHAPTER    NINTH. 

Of  the  Decay  of  the  Temporary  Teeth,        .         .         .  105 

CHAPTER    TENTH. 

Of  the  Diseases  which  attend  Dentition,          .         .         .  108 

CHAPTER    ELEVENTH. 

The  Analysis  of  the  Human  Teeth,         ....  123 

Analysis  of  the  Enamel, 125 

EXPLANATION   OF   PLATES   TO   PART  FIRST. 

Plate  One, 131 

Plate  Two, 132 

Plate  Three, 134 

Plate  Four, 135 

Plate  Five, 136 

Plate  Six,             136 

Plate  Seven, 137 

Plate  Eight, 140 

Plate  Nine, 141 


CONTENTS.  XV 

Plate  Ten, 143 

Plate  Eleven, 145 

Plate  Twelve, 147 

Plate  Thirteen, 148 

Plate  Fourteen, 149 

Plate  Fifteen, 150 


PART    SECOND. 

The    History    and    Treatment    of    the    Diseases    of    the 

Teeth,  Gums,  &.c.  &c, 151 

Introduction, 153 

CHAPTER    FIRST. 

Of  Caries, 157 

Proximate  Cause  of  Caries,        ......  160 

Predisposing  Cause  of  Caries, 166 

Prevention  of  Caries,        .         .         .         .         .         .         .  172 

Treatment  of  Caries,     .         .         .         .         .         .         .  1 76 

CHAPTER    SECOND. 

Of  Filing  the  Teeth, 179 

CHAPTER    THIRD. 

Of  Stopping  the  Teeth, 185 

CHAPTER  FOURTH. 

Tooth-Ache, 197 

Treatment  of  Tooth- Ache,             198 

CHAPTER    FIFTH. 

Of  the  Extraction  of  the  Teeth,            ....  209 

Instruments  Employed  in  the  Operation,        .         .         .         .210 

The  Key  Instrument,          ......  ib. 


Xvi  CONTENTS. 

The  Paces, 212 

The  Perpendicular  Extractor,     .....  213 

Of  the  Forceps,     ........  ib. 

Forceps  for  the    Extraction  of  the    Superior  Incisores  and 

Cuspidati, 215 

Forceps  for  the  Extraction  of  the  Superior  Molares,        .         .  216 

Forceps  for  the  Extraction  of  the  Superior  Dentes  Sapientia?,  217 
Forceps  for  the  Extraction  of  the  Bicuspides  of  both  Jaws  and 

the  Inferior  Cuspidati  and  Dentes  Sapientiac,        .         .  ib. 
Forceps  for  the  Extraction  of  the  Inferior  Incisores,        .         .218 

Forceps  for  the  Extraction  of  the  Inferior  lYFolares,     .         .  ib. 

Manner  of  Extracting  Teeth, 219 

Directions  for  the  Extraction  of  the  Incisores  and  Cuspidati,  220 

Directions  for  the  Extraction  of  the  Bicuspides  and  Molares,  222 

Directions  for  the  Extraction  of  Roots  of  Teeth,         .         .  229 

Particular  Directions  for  the  use  of  the  Key  Instrument,         .  233 

Hemorrhage  after  Extraction,     .*....  237 

CHAPTER    SIXTH. 

Of  Exostosis  of  the  Fangs  of  the  Teeth,          .         .         .  238 

CHAPTER    SEVENTH. 

Of  Necrosis  affecting  the  Fangs  of  the  Teeth,     .         .  245 

CHAPTER    EIGHTH. 

Of  the  Disease  resembling  Spina-Ventosa,         .         .         .  247 

CHAPTER    NINTH. 

Of  the  Removal  of  the  Enamel  by  the  Denuding  Process,  249 

CHAPTER    TENTH. 

Of  the  Wearing  of  the  Teeth  by  Mastication,          .         .  252 

CHAPTER    ELEVENTH. 

Of  Fractures  of  the  Teeth, 254 


CONTENTS.  XV11 

CHAPTER    TWELFTH. 

Of  the  Diseases  of  the  Gums,      ......     260 

Of  the  Scurvy  in  the  Gums,       ......         261 

Of  Preternatural  Growth  of  the  Gums,         ....     265 

CHAPTER    THIRTEENTH. 
Of  Gum-Boil  and  Abscess, 275 

CHAPTER    FOURTEENTH. 

Of  the  Diseases  of  the  Alveolar  Processes,     .         .  .     286 

CHAPTER    FIFTEENTH. 

Of  Tartar  (Salivary  Calculus)  of  the  Teeth,       .         .         296 
Analysis  of  the  Tartar,  .......     302 

Analysis, 303 

CHAPTER    SIXTEENTH. 
Of  Scaling  (Removing  the    Tartar)  of  the  Teeth,  .     306 

CHAPTER    SEVENTEENTH. 
Of  the  Effects  of  Mercury  upon  the  Teeth,        .         .         309 

CHAPTER    EIGHTEENTH. 
Of  the  Diseases  of  the  Antrum  Maxillare,      .         .         .     317 

CHAPTER    NINETEENTH. 
Of  Luxation  of  the  Lower  Jaw, 325 

EXPLANATION    OF    PLATES    TO    PART    SECOND. 

Plate  Sixteen, 353 

Plate  Seventeen,        .........  337 

Plate  Eighteen, 338 

Plate  Nineteen,         .  339 


Will  CONTENTS. 

Plate  Twenty, 340 

Plate  Twenty-one, 341 

Plate  Twenty-two, 342 

Plate  Twenty-three, 343 

Plate  Twenty -four, 344 

Plate  Twenty-five, 345 

Plate  Twenty-six, 346 

Plate  Twenty-seven, 347 

Dissection  of  Tumour,             349 


PART    THIRD. 

Artificial  Teeth,  Obturators  and  Palates,    .         .         .         351 

CHAPTER    FIRST. 
Artificial  Teeth,  ........         353 

CHAPTER    SECOND. 

Of  the  Manner  of  Inserting  a  Pivot  Tooth,      .         .         .     370 
Manner  of  Preparing  the  Root,  .....         371 

Of  the  Manner  of  Fitting  and  Attaching  a  Tooth  to  the  Root,      376 

CHAPTER    THIRD. 

Of  the  Manner  of  Fitting  and  Adapting  a  Plate,  and  At- 
taching Clasps  and  Artificial  Teeth  to  it,        .         .         380 
Of  the  Manner  of  taking  a  Wax  Impression,  .         .         .  .381 

Of  the  Manner  of  obtaining  a  Plaster  and  Metallic  Model  and 

Counter  Model, 382 

Of  the  manner  of  Fitting  and  Stamping  a  Plate  and  attaching 

Clasps  to  it, 384 

Of  the  manner   of  Fitting  and   Antagonizing  the  Teeth,  at- 
taching them  to  the  Plate,  and  finishing  the  work,        .         387 


CONTENTS.  XIX 

CHAPTER    FOURTH. 

Of  the  Teeth  to  which  it  is  most  proper  to  apply  Clasp*, 
and  the  manner  of  counteracting  the  injury  liable 
to  result  from  such  application, 395 

CHAPTER    FIFTH. 

OF  THE  CoNSTRUCTIOxN  OF  A  DOUBLE   SET  OF  ARTIFICIAL  TEETH 

MOUNTED    ON    PLATES    WITH    SPIRAL    SPRINGS,       .  .  .  399 

CHAPTER  SIXTH. 

Of  the  Construction  of  Plates  for  Artificial  Teeth  in 

particular  cases, 404 

CHAPTER    SEVENTH. 

Of  Artificial  Obturators  and  Palates,      ....         408 
Absence  of  a  Portion  of  the  Palatine  Organs,  .         .         .     ib. 

Of  the  Construction  of  Obturators, 412 

Of  Obturators  and  Palates  complicated  with  Artificial  Teeth,       417 
Of  the  Construction  of  a  complete  Palate  with  a  Set  of  Artificial 

Teeth, 419 

Artificial  Palate  and  Nose,  421 

EXPLANATION  OF   PLATES  TO   PART   THIRD. 

Plate  Twenty-eight, 429 

Plate  Twenty-nine, 430 

Plate  Thirty, 431 


INTRODUCTION  BY  THE  EDITOR, 
fifci  & 4v  •  '#& 

49  Wt       .y.ci  v&Wtfxm 

The  teeth  are  not  only  among  the  most  useful  and 
important  organs  of  the  human  body,  but  they  are  also 
among  the  most  ornamental.  They  play  an  important 
part  in  the  animal  economy,  and  form  an  essential  por- 
tion of  the  organism  of  man — contributing,  when  sound, 
to  the  health  of  the  whole  body,  and  when  diseased,  to 
the  impairment  of  many,  and  often  of  all  its  functional 
operations.  Planted  deeply  in  the  alveolar  border  of 
each  jaw,  they  are  important  both  in  an  anatomical  and 
in  a  physiological  point  of  view.  They  sustain,  through 
the  medium  of  the  fifth  pair  of  nerves,  an  intimate  re- 
lation with  the  brain  and  whole  nervous  system,  as  well 
as  with  all  the  parts  dependent  on  them.  They  are  the 
prime  organs  of  mastication — an  operation  which  consti- 
tutes the  first  stage  of  digestion,  and  which,  if  impro- 
perly performed,  necessarily  vitiates  the  whole  process 
of  assimilation.  They  contribute  too,  in  an  eminent 
degree,  to  distinct  enunciation,  and  by  preventing  the 
jaws  from  coming  together,  they  give  rotundity  and 
symmetry  to  the  face.  Therefore,  in  whatever  light 
they  may  be  viewed,  they  are  of  priceless  importance 
to  the  well-being  and  comfort  of  every  individual. 
4 


22  I  N  T  It  O  D  U  C  T  I  0  N . 

But  notwithstanding  the  value  and  importance  of  the 
teeth,  they,  like  other  parts  of  the  body,  are  liable  to 
disease,  and  are  often  destroyed  by  it  at  a  very  early 
period  of  life.  Unlike  other  parts  of  the  body,  how- 
ever, these  organs  are  not  endowed  with  recuperative 
powers.  When  attacked  by  disease,  art  only  can  stop 
its  progress,  and  repair  the  injury  which  it  has  inflicted ; 
and  happily  her  resources,  when  applied  in  time,  have 
been  found  amply  sufficient,  both  for  the  one  and  the 
other.  Skilful,  however,  must  be  the  hand,  and  perfect 
the  knowledge  of  the  operator,  who  deals  with  organs, 
the  diseases  of  which  can  only  be  arrested  by  mechani- 
cal means;  and,  it  is  greatly  to  be  regretted,  that  so  few 
of  the  practitioners  of  dental  surgery,  possess  these  in- 
dispensable qualifications.  The  numerous  unsuccessful 
operations  on  the  teeth,  daily  performed,  and  the  last- 
ing, and  often  irreparable  injury  resulting  therefrom,  are 
all  attributable  to  the  want  of  a  sufficiently  thorough, 
theoretical  and  practical  knowledge  of  this  branch  of 
the  curative  art. 

But  the  treatment  of  the  diseases  of  the  teeth  and  the 
replacement  of  their  loss  with  artificial  substitutes,  do  not 
comprise  all  the  duties  of  the  surgeon  dentist.  The 
treatment  of  the  various  affections  of  the  gums,  alveolar 
processes,  and  their  contiguous  parts,  as  well  as  the  man- 
agement of  second  dentition,  when  effected  in  a  faulty 
or  improper  manner,  and  the  correction  of  irregularity 
in  the  arrangement  of  these  organs,  all  come  legitimately 
within  his  province.  He  therefore  who  would  be  a  suc- 
cessful practitioner  of  the  dental  branch  of  medicine, 
should  not  only  be  thoroughly  skilled  in  the  various 
mechanical  manipulations  which  belong  to  it,  but  he 
should  also  have  a  knowledge  of  anatomy,  physiology, 
pathology,  and  the  therapeutical  indications  of  disease 


INTRODUCTION.  23 

generally.  Without  this  knowledge,  no  one  should  take 
upon  himself  the  responsibility  of  practising  the  profes- 
sion, and  to  obtain  it,  requires  much  time  and  close  and 
persevering  application.  Neither  mechanical  ability  nor 
the  highest  medical  attainments,  nor  both  combined, 
without  a  thorough  knowledge  of  the  diseases  of  the 
dental  apparatus  and  their  treatment,  can  make  a  skilful 
practitioner  of  this  branch  of  the  healing  art. 

That  any  one,  therefore,  should  be  guilty  of  the  egre- 
gious folly  of  committing  the  treatment  of  the  diseases  of 
organs  so  valuable  as  the  teeth,  to  an  individual  totally 
destitute  of  all  qualifications,  and  having  no  other  claim 
to  skill  in  their  management,  than  the  mere  assumption 
of  the  name  of  dentist,  is  almost  incredible;  and  yet  it 
is  done  every  day,  and  by  persons  who  would  not  think 
of  putting  a  watch,  or  any  common  jewelry  for  repair 
into  the  hands  of  a  man  not  known  to  be  well  skilled  in 
such  matters.  Such  inconsistency,  might  seem  paradox- 
ical, if  it  were  not  constantly  observed  in  individuals 
moving  in  the  most  learned  and  polished  walks  of  so- 
ciety, and  manifesting  in  most  matters  great  prudence, 
shrewdness  and  judgment.  But  this  is  not  so  culpable 
in  others,  when  medical  men,  eminent  for  erudition  and 
skill  in  their  profession,  have  been  known  to  employ  and 
recommend  practitioners  of  this  description.  Thus  en- 
couraged they  have  multiplied  with  most  astonishing 
rapidity,  and  if  it  were  not  that  some  men  of  education, 
talent  and  ingenuity  are  engaged  in  this  field  of  practice, 
they  would,  long  before  now,  have  destroyed  all  confi- 
dence in  the  alleviatory  resources  of  the  profession.  But 
thanks  to  the  efforts  and  unwearied  labour  of  such  men, 
notwithstanding  the  multiplication  of  empirics,  the  pro- 
gress of  the  science  and  art  of  dental  surgery  has  been 
rapid;  it  has  outstripped  the  most  ardent  flights  of  imagi- 


24  INTRODUCTION. 

nation;  and  has  already  attained  a  degree  of  excellence; 
which  a  few  years  ago  was  supposed  impossible. 

The  importance  of  a  higher  standard  of  qualification 
for  practitioners  in  this  department  is  beginning  to  be 
felt  every  where;  and  it  is  gratifying  to  perceive  that 
efforts  are  now  making  for  the  accomplishment  of  this 
important  object.  That  it  has  not  been  previously  done; 
is  not  at  all  surprising;  for  until  recently;  the  practice  had 
not  assumed  the  importance  it  now  possesses;  nor  had 
any  public  or  ample  private  facilities  been  furnished  for 
the  acquisition  of  a  thorough  and  comprehensive  know- 
ledge of  the  art.  Therefore;  it  was  only  by  the  appli- 
cation of  rare  abilities  and  the  most  untiring  efforts;  that 
those  who  have  attained  to  eminence  and  skill  in  it;  were 
enabled  to  do  so. 

But  the  dawn  of  a  brighter  day  has  begun.  Ample 
facilities  are  now  furnished  by  the  Baltimore  and  Cin- 
cinnati Colleges  of  Dental  Surgery;  for  obtaining  a  tho- 
rough medico-dental  education.  The  former  was  char- 
tered by  the  Legislature  of  Maryland  in  1840;  and  has 
been  in  successful  operation  five  years;  the  latter  was 
chartered  about  twelve  months  since;  by  the  Legislature 
of  Ohio;  and  commenced  operation  in  November  last. 

The  advantages  of  collegiate  over  private  instruction 
are  as  great  in  dental  surgery  as  they  are  in  medicine 
and  general  surgery.  Few  private  teachers  are  provided 
with  the  means  and  necessary  facilities  for  imparting  a 
thorough  knowledge  of  the  various  branches  that  should 
enter  into  the  professional  education  of  an  accomplished 
dentist;  and  most  of  those  who  commenced  practice  with 
no  other  information  upon  the  subject;  than  that  which 
they  obtained  from  private  instructors;  did  so  with  ex- 
ceedingly limited  qualifications;  and  soon  found  that  they 
had  still  much  to  learn. 


INTRODUCTION.  25 

The  study  of  dental  surgery  is  now  invested  with 
peculiar  interest.  A  revolution  has  commenced  in  the 
ranks  of  the  profession,  which  must  before  long  result  in 
an  entire  change  in  the  character  of  the  pursuit  and  its 
relation  to  the  liberal  sciences.  The  number  of  edu- 
cated men  engaged  in  it  is  rapidly  increasing,  and  they 
are  uniting  their  energies  to  accomplish  this  change. 

They  have  already  done  much  toward  effecting  it,  and 
the  result  of  their  past  labours  encourages,  nay  warrants, 
the  belief  that  the  day  is  not  distant,  when  none  but  men 
capable  of  practising  the  art  upon  scientific  principles, 
and  of  enriching  it  by  the  result  of  enlightened  observa- 
tion and  critical  research,  shall  be  permitted  to  exercise 
its  duties.  Then,  and  not  till  then,  wTill  the  malign  influ- 
ence of  dental  empiricism  cease,  and  the  sanatary  and 
restorative  resources  of  this  branch  of  medicine  be  pro- 
perly appreciated  and  acknowledged. 


PART    I, 


THE  HISTORY  OF  THE    FORMATION    AND   STRUCTURE  OF  THE 

TEETH. 

THE    SYMPTOMATIC    DISEASES     INCIDENTAL     TO     THE    FIRST 

DENTITION. 

THE    CHANGES    WHICH    TAKE     PLACE    DURING    THE    SECOND 

DENTITION; 


AND 


THE  TREATMENT  TO  PREVENT  AND  REMEDY  IRREGULARITIES 
IN  THE  ARRANGEMENT  OF  THE  TEETH. 


PART  FIRST 


CHAPTER    FIRST. 

OF   THE    FORMATION    OF   THE   TEMPORARY   SET   OF   TEETH. 

When  the  foetus  has  advanced  so  far  in  the  organiza- 
tion of  its  different  parts,  as  to  take  some  determinate 
form  or  figure,  we  may  perceive  a  considerable  progress 
in  the  preparatory  steps  for  the  formation  of  the  teeth. 

As  soon  as  the  ossific  deposit  commences  in  the  cartil- 
aginous parts  of  the  embryo,  both  jaws  are  filled  with 
small  membranous  sacs;  and,  in  the  anterior  parts,  we 
may  perceive  the  rudiments  of  alveolar  processes. 

In  a  foetus  of  about  four  months,  the  jaw  bones  are 
distinctly  formed;  but  at  this  time  they  only  consist  of 
thin  grooved  bones,  having  a  cavity  extending  through 
their  whole  length.*  In  the  under  jaw,  anteriorly,  this 
cavity  is  narrower  and  deeper;  but,  posteriorly,  it  becomes 
wider  and  more  shallow.  At  this  time,  if  the  mem- 
branous parts  be  removed,  small  processes  of  bone  may 
be  perceived  shooting  across  from  each  side;  which  as 

*  The  description  of  what  takes  place  in  one  jaw,  will  completely  exhibit  what  con- 
cerns the  formation  of  the  teeth  in  both ;  therefore,  in  order  to  avoid  confusion,  I  shall 
refer  to  the  under  jaw  only. 

5 


30  OF    THE    FORMATION    OF    THE 

the  foetus  increases  in  growth,  gradually  acquire  more 
distinctness,  and  at  length  form  separate  sockets  for  the 
teeth.* 

During  the  foetal  state,  and  also  for  some  months  after 
birth,  the  blood  vessels  and  nerves  belonging  to  the  teeth, 
run  along  at  the  bottom  of  this  cavity,  immediately  below 
the  pulps  of  the  teeth;  but  afterwards  a  distinct  canal  is 
formed,  through  which  the  principal  vessels  and  nerves 
pass;  separate  filaments  being  sent  off  to  the  several  teeth. 
When  the  gum  which  covers  the  alveolar  groove  of  a 
foetus  of  the  age  above-mentioned,  is  stript  off  from  the 
bone,  small  processes  or  elongations  from  the  inner  surface 
of  the  gums  may  be  distinctly  perceived;  these  are  the 
first  appearances  of  the  pulps  from  which  the  teeth  are 
formed,  f 

The  alveolar  processes  soon  become  perfectly  distinct; 
for,  the  bony  partitions  w^hich  divide  the  longitudinal 
cavity  in  the  jaw,  rise  to  the  upper  margin;  and  thus 
those  membranous  processes,  now  enlarged  and  become 
more  evolved,  begin  to  be  contained  in  separate  cells. J 

In  a  foetus  of  about  four  months  old,  the  rudiments  of 
the  teeth  may  be  very  distinctly  seen;  upon  examining 
those  substances  found  in  the  jaws,  they  are  seen  to  be 
soft,  or  pulpy  bodies,  bearing  a  resemblance  to  the  figure 
of  the  body  of  the  tooth  to  be  formed,  and  each  of  them 
is  contained  in  a  membrane  proper  to  itself.  || 

For  some  time  during  the  formation  of  the  teeth,  the 
alveoli  grow  much  faster  than  the  teeth  themselves,  which 
are  consequently  but  loosely  contained  within  them.  At 
the  time  of  birth,  the  alveolar  processes  have  increased  so 
much,  that  they  almost  enclose  or  cover  the  teeth ;  thus  a 
firm  support  is  given  to  the  gums,  and  the  infant  is 
enabled  to  make  considerable  pressure  in  sucking,  &c. 

*  Plate  I.  Fig.  1.  \  Plate  I.  Fig.  2.         \  Plate  I.  Fig.  3,  5.  ||  Plate  I.  Fig.  4. 


TEMPORARY    SET    OF    TEETH.  31 

without  injury  to  the  progress  which  is  going  on  under- 
neath. 

The  ossification  of  the  teeth  begins  to  take  place  very 
early;  it  is  first  visible  upon  the  tips  of  the  incisores.  In 
a  fetus  of  about  five  or  six  months,  ossification  has  com- 
menced upon  the  pulps  of  the  incisores  and  cuspidati,  and 
on  the  points  of  the  molares;  this  gradually  advances  and 
extends  itself,  over  the  pulp,  down  to  the  neck  of  the 
tooth,  from  the  cutting  edges  or  highest  points;  where  it 
had  first  commenced. 

At  the  time  of  birth,  the  bodies  of  ten  teeth  are  distinct- 
ly formed  in  each  jaw;  these  are  the  teeth  designed  to 
serve  during  the  years  of  childhood,  and  are  commonly 
called  the  temporary,  shedding,  or  milk  teeth.* 

These  temporary  teeth,  which  constitute  the  first  set, 
are  twenty  in  number,  and  are  divided  into  three  classes, 
incisores,  cuspidati  and  molares.  In  each  jaw  there  are 
four  incisores,  two  cuspidati,  and  four  molares,  and  the 
teeth  on  one  side  of  the  mouth  correspond  in  figure  with 
those  of  the  other,  so  that  they  are  situated  in  pairs. 

Besides  these  twenty  teeth,  there  are  in  a  very  early 
stage  of  their  formation,  the  rudiments  of  some  other 
teeth,  which  are  to  form  part  of  the  permanent  or  adult 
set.f 

[At  birth,  the  jaws  contain  the  rudiments  of  fifty-two 
teeth — twenty  temporary  and  thirty-two  permanent.] 

After  birth,  as  the  ossification  goes  on,  the  teeth  be- 
come too  long  to  be  contained  within  the  alveolar  cavity, 
they  therefore  begin  to  make  pressure  upon  those  parts 
which  cover  them;  this  produces  the  process  of  absorp- 
tion, which  proceeds  with  the  enlargement  of  the  tooth, 
first  removing  the  membranes  which  enveloped  the  teeth, 
and  afterwards  the  thick  gum  which  covered  them,  this 

*  Hate  II.  Fig.  1.  f  Plate  II.  Fig.  1.  a.  b. 


32  OF    THE    FORMATION    OF    THE 

gradually  becoming  thinner  and  thinner,  till  at  length  the 
teeth  are  suffered  to  pass  through. 

There  is  considerable  variety  as  to  the  precise  time 
when  the  teeth  begin  to  make  their  appearance.  This 
frequently  seems  to  depend  upon  the  health  and  vigour 
of  the  child:  for  sometimes  the  first  tooth  comes  as  early 
as  four  or  five  months,  while  on  the  contrary,  in  those  of 
more  delicate  and  weakly  constitutions,  no  tooth  makes 
its  appearance  until  the  child  is  ten  or  twelve  months  old: 
and  it  is  not  very  uncommon  for  a  child  to  be  turned  of 
fourteen  months  before  any  tooth  appears. 

It  may  be  expected  that  the  formation  of  the  teeth  will 
go  on  more  rapidly  in  the  healthy,  and  proceed  more 
slowly  in  the  weak  and  delicate :  Yet  there  are  excep- 
tions to  this,  for  often  the  teeth  seem  not  to  be  influenced 
by  any  state  of  health.  Those  of  a  weakly  child  will 
sometimes  arise  in  rapid  succession,  while  those  of  one 
more  robust  will  often  come  forward  but  slowly. 

In  general;  children  begin  to  have  their  teeth  about  the 
sixth,  seventh,  or  eighth  month  after  birth:"  those  which 
correspond  with  each  other  generally  appearing  about 
the  same  time,  first  in  the  under  jaw,  and  then  in  the 
upper. 

The  following  is  the  order  in  which  the  teeth  of  a  child 

*  Sometimes  a  child  is  born  having  one  or  two  teeth  :  these  are  generally  the  cen- 
tral incisores  of  the  under  jaw:  In  such  cases  the  socket  for  the  forming  tooth  has  not 
been  sufficiently  deep,  and  therefore  the  tooth  has  passed  through  the  gum  premature- 
ly.    These  early  productions  are  only  the  upper  parte 

having  yet  been  formed.    And  as  they  have  only  a  weak  attachment  to  the  gums, 
they  soon  get  loose,  prodv.  -Merable  inflammation  in  the  mouth  of  the  child, 

u  well  as  occasioning  inconvenience  to  the  mother.    It  is  therefore  advisable  to 
tract  them  immediately,  for  they  can  never  come  to  perfection. 

:h.  which  appear  through  the  gums  at  birth,  had  as  the  raft  - .  Jways 

a  weak  attachment,  and  soon  get  loose,  it  would  be  proper  to  adopt  the  practice  which 

he  recommends.     But  having  met  with  cases  where  they  were  firmly  articulated,  and 

productive  of  no  unpleasant  en  ot  join  with  him  in  recommending 

their  immediate  removal ;  this  operation  should  only  be  resorted  to  when  they  give 

•  J  irritation  of  the  gor 


TEMPORARY    SET    OF    TEETT1.  33 

generally  appear. — The  first  teeth  are  the  central  incisores 
of  the  under  jaw,  one  generally  coming  a  few  days  before 
the  other;  then,  in  the  course  of  a  month,  the  two  central 
incisores  of  the  upper  jaw.  These  are  succeeded  in  a 
few  weeks  by  the  lateral  incisores  of  the  under  jaw,  and 
then  soon  after  by  the  lateral  incisores  of  the  upper  jaw. 
The  cuspidati  are  generally  slower  in  completing  their 
growth  than  the  molares,  they  are  placed  deeper  in  the 
jaw,  and  therefore  are  preceded  by  the  first  molares. 
The  small  molares  of  the  under  jaw  usually  come  before 
those  of  the  upper;  they  commonly  appear  about  the 
fourteenth  or  sixteenth  month,  and  are  soon  met  by  those 
of  the  upper  jaw.  After  these,  the  cuspidati  come 
through,  first  in  the  lower  jaw,  and  then  in  the  upper. 
At  some  time  between  two  years  and  two  years  and  half, 
the  second  molares  make  their  appearance,  and  thus 
complete  the  temporary  set  of  teeth. * 

The  obtaining  of  the  temporary  teeth  usually  occupies 
a  child  from  about  the  sixth  or  eighth  month  until  be- 
tween two  or  three  years  of  age.  The  teeth  most  com- 
monly follow  the  order  above-mentioned;  but  this  is  not 
always  to  be  expected :  there  are  often  great  irregulari- 
ties; sometimes  the  upper  teeth  appear  before  the  under; 
now  and  then  the  lateral  incisores  precede  the  central. 
I  once  saw  an  instance  of  the  first  molares  of  the  under 
jaw  appearing  before  the  lateral  incisores;  and  sometimes 
more  teeth  come  about  the  same  time  than  ought  natural- 
ly to  be  expected.  These  cases  of  irregular  succession 
of  the  teeth  are  often  attended  with  considerable  derange- 
ment of  health,  and  alarming  symptoms  of  irritation. 

[The  periods  for  the  eruption  of  the  temporary  teeth 
are  stated  by  Mr.  Thomas  Bell,  to  be,  for  the  four  central 
incisores,  from  the  fifth  to  the  eighth  month ;  for  the  four 

•Platell.  Fis.  2,3,  4. 


34  FORMATION     OF    TEMPORARY    TEETH. 

lateral^  from  the  seventh  to  the  tenth;  for  the  four  anterior 
molares,  from  the  twelfth  to  the  sixteenth;  for  the  cus- 
pidate from  the  fourteenth  to  the  twentieth;  and  for  the 
posterior  molares,  from  the  eighteenth  to  the  twentieth. 
I  am  however  of  the  opinion,  that  he  is  somewhat  in 
error  with  regard  to  that  of  the  last.  The  second 
temporary  molares  seldom  appear  before  the  twenty- 
fourth  month.] 


CHAPTER  SECOND. 

OF  THE  FORMATION  OF  THE  PERMANENT  SET  OF  TEETH. 

In  the  management  of  the  teeth  of  children,  it  is 
highly  necessary  that  the  surgeon  should  have  a  perfect 
knowledge  of  the  order  in  which  the  teeth  of  the  perma- 
nent set  are  formed,  and  of  the  time  when  each  tooth  is 
expected  to  pass  through  the  gums. 

The  formation  and  perfection  of  this  set  of  teeth, 
occupy  a  very  important  portion  of  our  limited  exist- 
ence ;  no  less  than  twenty  years,  and  often  more,  being- 
necessary  for  their  complete  evolution.  Nature  begins 
to  attend  to  the  production  of  these  permanent  instru- 
ments of  mastication,  even  before  birth,  and  in  many 
instances,  they  are  not  wholly  completed  before  the 
twenty-fifth,  or  thirtieth  year. 

The  permanent  set  of  teeth  vary  much  from  the  tem- 
porary set,  some  of  the  teeth  being  much  larger,  and 
others  differing  much  in  figure;  they  are  in  number 
thirty-two,  and  therefore  consist  of  twelve  teeth  more 
than  the  temporary  set. 

This  set  of  teeth  may  be  divided  into  two  distinct 
classes;  those  which  are  to  succeed  the  temporary,  and 
those  which  are  superadded;  the  formation  of  both  these 
divisions  begins  nearly  about  the  same  time,  and  the 
progress  furnishes  one  of  the  most  curious  changes  the 
animal  frame  can  exhibit. — The  incisores  and  cuspidati  of 


36  OF    THE    FORMATION    OF    THE 

the  child  are  succeeded  by  teeth  similar  in  form;  but 
larger  in  size,  and  they  have  the  same  appellation;  but 
the  teeth,  which  take  the  places  of  the  temporary  mo- 
lares,  are  much  smaller,  and  being  divided  at  their  grind- 
ing surfaces  into  two  points,  are  called  bicuspides.  The 
molares  of  the  adult  are  the  teeth  which  are  superadded, 
and  these  succeed  one  another  as  the  jaws  advance  in 
growth.* 

The  teeth  of  the  adult  are  divided  into  four  classes: 
incisores,  cuspidati,  bicuspides,  and  molares. 

The  teeth  differ  very  much  in  the  figure  of  their 
bodies,  and  in  the  number  and  shape  of  their  fangs. 
The  cuspidati  are  of  a  middle  nature  between  the  inci- 
sores and  the  bicuspides;  as  are  the  latter  between  the 
cuspidati  and  the  molares. 

The  incisores,  or  cutting  teeth,  are  situated  in  the  ante- 
rior part  of  the  jaw,  and  form  the  front  of  the  mouth. 
In  each  jaw  they  are  four  in  number,  and  are  so  placed, 
that  the  two  central  stand  somewhat  more  advanced  than 
the  lateral. 

The  bodies  of  the  incisores  are  broad,  and  rather  flat. 
The  anterior  surface  is  convex,  the  posterior  concave; 
they  both  go  off  from  the  neck  of  the  tooth  somewhat 
sloping:  the  two  surfaces  terminate  in  a  cutting  edge, 
wrhich  is  placed  in  a  direct  line  with  the  apex  of  the  fang. 
When  viewed  in  front,  the  cutting  edge  is  seen  to  be  the 
broadest  part  of  the  tooth,  but  gradually  becomes  smaller 
as  we  approach  to  the  neck.  When  viewed  laterally, 
the  cutting  edge  is  the  thinnest,  and  the  tooth,  to  the 
neck  of  it,  increases  in  thickness.  This  gives  to  the 
body  of  the  tooth  the  form  of  a  wedge,  which  is  its  true 
office,  it  being   used   to  cut  or  divide   soft   substances. 

The  enamel  is  continued  farther,  and  is  thicker  on  the 

*  Plate  VII. 


PERMANENT    SET    OF    TEETH.  37 

anterior  and  posterior  surfaces  than  on  the  sides;  it  is 
even  thicker  on  the  fore  part  than  on  the  back  part  of  the 
tooth.  The  fangs  are  conical,  and  are  shorter  than  those 
of  the  cuspidati. 

In  the  upper  jaw,  the  central  incisores  are  much 
broader  and  larger  than  the  lateral;  in  the  lower  jaw 
they  are  all  nearly  of  the  same  size,  but  much  smaller 
than  those  of  the  upper  jaw. 

The  cuspidati  are  four  in  number,  one  of  them  being 
placed  on  the  outer  side  of  each  of  the  lateral  incisores. 

The  shape  of  the  crown  of  a  cuspidatus  is  like  that  of 
an  incisor,  with  its  corners  rubbed  off,  so  as  to  end  in  a 
point,  instead  of  a  broad  edge.  The  fang  is  thicker  and 
larger,  and  is  more  depressed  at  the  sides,  which  causes 
it  to  appear  considerably  broader,  when  viewed  laterally, 
than  when  seen  in  front.  The  fang,  which  is  the  largest 
of  any  of  the  teeth,  may  be  felt  with  the  finger,  running 
up  a  considerable  length,  and  projecting  beyond  those  of 
the  other  teeth. 

The  cuspidati  of  the  lower  jaw  very  much  resemble 
those  of  the  upper,  both  in  figure  and  in  length.  The 
enamel  covers  more  of  the  lateral  parts  of  these  teeth 
than  of  the  incisores :  When  they  are  first  formed  they 
are  pointed,  but  by  the  friction  of  each  upon  the  other  in 
mastication,  they  become  rounded,  and  sometimes  ac- 
quire a  flat  edge. 

The  use  of  the  cuspidati  is  not  like  that  of  the  inci- 
sores, to  cut  and  divide  substances,  nor  like  the  molares 
for  mastication ;  but  they  are  similar  to  the  canine  teeth 
of  carnivorous  animals,  and  seem  to  be  designed  for  the 
laying  hold  of  and  tearing  of  substances. 

The   bicuspides  are  situated  immediately  behind   the 
cuspidati.     They  were  formerly  called  the  first  and  sec- 
ond grinders,  but  as  they  do  not  possess  the  true  figure 
f> 


38  OF    THE    FORMATION    OF    THE 

of  grinders,  and  only  have  an  intermediate  resemblance 
between  those  teeth  and  the  cuspidati,  Mr.  Hunter  con- 
sidered them  as  a  particular  class. 

These  teeth  are  very  much  like  each  other,  and  when 
viewed  as  they  are  situated  in  the  mouth,  are  not  unlike 
the  cuspidati.  They  are  eight  in  number;  those  belong- 
ing to  the  upper  jaw  have  the  body  divided  into  two 
points,  one  external,  the  other  internal.  Their  fangs  ap- 
pear as  if  compressed  at  the  sides,  and  resemble  two 
fangs  united,  with  a  depression  running  between  them : 
commonly  the  first  bicuspis  has  two  small  fangs,  the  sec- 
ond has  seldom  more  than  one;  but  in  this  they  are  sub- 
ject to  variety. 

[The  editor  has  several  superior  bicuspides  in  his  ana- 
tomical cabinet,  each  of  which  has  three  fangs.] 

The  bicuspides  of  the  under  jaw  are  smaller  than  those 
of  the  upper;  the  points  upon  their  surfaces  are  not  so 
distinct,  and  they  have  only  one  fang.  The  enamel  is 
distributed  nearly  equally  around  the  crown,  and  they 
stand  in  the  jaw  almost  perpendicularly,  but  have  a  slight 
inclination  inwards. 

The  molares,  or  grinders,  are  placed  behind  the  bicus- 
pides; there  are  three  on  each  side  of  the  jaw,  making 
twelve  in  the  whole.  The  first  and  second  molares  are 
so  much  alike  in  every  particular,  that  the  description  of 
one  will  convey  a  perfect  idea  of  the  other.  The  third 
grinder  has  several  peculiarities,  and  therefore  must  be 
described  separately.  The  molares  are  the  largest  teeth ; 
they  have  a  broad  base,  furnished  with  several  points, 
which  fits  them  for  their  office  in  grinding  of  food,  and 
they  have  several  fangs. 

The  molares  of  the  under  jaw  have  an  inclination  in- 
wards, while  those  of  the  upper  jaw  are  placed  nearly 
perpendicularly  with  respect  to  the  jaw. 


PERMANENT    SET    OF    TEETH.  39 

The  upper  grinders  have  commonly  three  fangs,  two 
situated  on  the  outer  part  of  the  tooth,  and  one  on  the  in- 
ner; the  inner  fang  is  very  oblique  in  its  direction,  and  is 
larger  and  rounder  than  the  others.  Those  of  the  under 
jaw  have  two  fangs,  one  placed  forwards,  the  other  back- 
wards; they  are  rather  flat,  and  continue  broad  all  down 
their  length. 

Sometimes  molares  of  the  upper  jaw  are  met  with  hav- 
ing four  distinct  fangs.*  I  have  one  with  five  fangs, 
which  is  the  only  one  I  ever  saw.f  The  molares  of  the 
under  jaw  now  and  then  have  three  fangs.  J 

The  third  molaris  is  called  dens  sapientiae;  it  is  smaller 
than  the  others,  its  body  is  rather  rounder,  and  the  fangs 
are  not  so  regular  and  distinct :  they  often  appear  as  if 
squeezed  together,  and  sometimes  there  is  but  one  fang. 
The  dentes  sapientiae  of  the  lower  jaw  often  have  their 
fangs  curved,  and  sometimes  they  are  so  much  inclined 
inwards,  as  scarcely  to  rise  above  the  ridge  of  the  coro- 
noid  process. 

The  incisores  of  the  upper  jaw  being  much  broader 
than  the  same  teeth  in  the  under  jaw,  cause  the  other 
teeth  to  be  placed  farther  back  in  the  circle  than  the  cor- 
responding teeth  of  the  lower  jaw ;  hence  in  a  well-formed 
mouth,  when  the  teeth  are  shut  close,  the  central  inci- 
sores of  the  upper  jaw  come  over  the  central  and  half  of 
the  lateral  incisores  of  the  lower  jaw :  The  lateral  incisor 
of  the  upper  jaw  covers  the  half  of  the  lateral  incisor,  and 
more  than  half  of  the  cuspidatus  of  the  under  jaw.  The 
cuspidatus  of  the  upper  jaw  falls  between  and  projects  a 
little  over  the  cuspidatus  and  first  bicuspis  of  the  under 
jaw.  The  first  bicuspis  of  the  upper  jaw  falls  partly  upon 
the  two  bicuspides  in  the  lower  jaw:  The  second  bicus- 
pis shuts  upon  the  second  bicuspis  and  the  first  molaris: 

•Plate  IX.  Fig  11.  f  Fig.  IS.  fFig.6. 


40  OF    THE    FORMATION    OF    THE 

The  first  upper  molaris  covers  two-thirds  of  the  first  and 
part  of  the  second  molaris  of  the  under  jaw:  The  second 
upper  molaris  shuts  upon  the  remainder  of  the  second 
and  part  of  the  third;  and  the  third  molaris  of  the  upper 
jaw,  being  smaller  than  that  in  the  under  jaw;  shuts  even 
upon  it.* 

From  this  mechanism  of  the  teeth  their  power  in  mas- 
tication is  increased,  and  if  one  tooth  be  extracted,  the 
antagonist  tooth  does  not  become  useless,  since  it  can  in 
part  act  upon  another. 

[When  this  is  not  the  case,  as  often  happens,  it  be- 
comes elongated,  or  is  gradually  forced  from  its  socket 
by  a  deposition  of  bony  matter  at  the  bottom  of  the  alveo- 
lus; and  from  this  it  would  seem,  that  when  a  tooth  has 
lost  its  antagonist,  it  becomes,  in  some  degree,  obnoxious 
to  the  system,  and  an  effort  is  made  by  the  economy  to 
expel  it  from  the  jaw.  In  accordance  with  this  indica- 
tion of  nature,  Dr.  Koecker  recommends  the  removal  of 
such  teeth.  But  as  this  tendency  can  in  many  cases,  by 
constant  attention  to  the  cleanliness  of  the  tooth,  be  mea- 
surably counteracted,  the  operation  should  be  resorted  to 
only  in  those  cases  where  it  is  absolutely  required.] 

The  permanent  incisores  and  cuspidati  are  formed 
behind  the  temporary  incisores  and  cuspidati;  the  bicus- 
picles  underneath  the  temporary  molares,  and  they  are 
contained  in  sockets  of  their  own. 

The  molares  are,  one  after  the  other,  formed  in  par- 
ticular parts  of  the  jaws:  In  the  upper  jaw,  that  posterior 
part  called  the  tubercle,  is  the  place  for  the  formation  of 
the  upper  molares;  and  the  molares  of  the  under  jaw  are 
formed  in  that  part  situated  beneath  the  coronoid  process, 
one  succeeding  the  other,  as  the  jaws  in  their  growth 
carry  the  teeth  forwards. 


PERMANENT    SET    OF    TEETH.  41 

Those  teeth  of  the  permanent  set  which  first  begin  to 
be  formed  are  the  anterior  molares,  the  pulps  of  which 
may  be  found  in  a  foetus  a  short  time  previous  to  birth, 
when  they  are  situated  quite  at  the  posterior  parts  of  the 
jaws.  At  the  time  of  birth  ossification  has  commenced 
upon  their  highest  points;  at  this  time  also,  on  examining 
the  membranes  of  the  temporary  incisores,  small  mem- 
branous sacs,  containing  a  jelly-like  substance,  will  be 
found  attached  to  them  at  the  posterior  and  upper  part. 
These  are  the  early  rudiments  of  the  permanent  molares ; 
ossification  commences  upon  their  tips  soon  after  birth, 
but  always  first  in  the  lower  jaw. 

When  an  infant  has  cut  the  central  incisores  of  the 
upper  jaw,  and  the  four  incisores  of  the  under  jaw,  a  con- 
siderable progress  has  been  made  in  the  ossification  of  the 
permanent  incisores  and  first  molares;  in  the  under  jaw 
it  has  begun  on  the  points  of  the  cuspidati,  and  in  the 
upper  jaw,  pulps  for  cuspidati  have  become  distinct,  the 
ossification  of  which  usually  commences  when  a  child  is 
aged  about  sixteen  months.* 

Between  two  and  three  years,  when  all  the  temporary 
teeth  have  appeared  through  the  gums,  the  size  of  those 
permanent  teeth  already  mentioned  is  much  increased, 
and  ossification  has  commenced  upon  the  points  of  the 
bicuspides  of  the  under  jaw.f 

After  this  time  the  teeth  very  much  alter  their  position : 
At  first  the  permanent  teeth  are  contained  in  the  same 
sockets  as  the  temporary;  but  as  the  formation  of  both 
sets  advances,  the  permanent  teeth,  by  the  growth  of  the 
alveolar  processes,  become  placed  in  a  kind  of  niche; 
there  is  also  a  small  bony  process,  shooting  across  the 
bottom  of  the  common  socket,  which  gradually  increases, 
till  at  length  nearly  a  complete  separation  is  produced, 

*  Plate  II.  Fig.  2  and  3.  t  Plate  II.  Fig.  4. 


42  OF    THE    FORMATION    OF    THE 

and  the  permanent  teeth  are  contained  in  sockets  of  their 
own.  This  may  be  very  well  observed  in  the  head  of  a 
child  of  about  four  years  of  age;  at  this  time  the  jaws 
have  become  deeper,  in  consequence  of  the  complete  for- 
mation of  the  temporary  teeth  and  their  alveolar  proces- 
ses, and  the  permanent  set  may  be  presented  to  view, 
upon  removing  the  external  plate  of  the  jaws.* 

About  this  age  the  ossification  of  the  incisores,  cuspi- 
dati,  first  bicuspides,  and  first  molares,  is  much  advanced, 
some  progress  has  been  made  in  the  formation  of  the 
second  molares,  and  soon  after,  the  ossification  of  the 
second  bicuspides  commences. 

At  about  six  years  of  age  those  teeth  designed  to  suc- 
ceed the  temporary  ones,  and  the  first  and  second  molares, 
are  in  considerable  forwardness,  and  if  none  of  the  tem- 
porary teeth  have  yet  heen  removed,  there  are  at  this 
time  in  the  head,  forty-eight  teeth,  twenty  in  situ,  and 
within  the  jaws  beneath  the  gums,  in  the  progress  of  for- 
mation, twenty-eight,  f 

In  the  eighth  or  ninth  year  the  formation  of  the  third 
molares,  or  dentes  sapientise  begins,  by  this  time  some  of 
the  front  teeth  have  been  shed,  and  all  the  others  are 
much  advanced  in  growth. J 

[The  rudiments  of  the  dentes  sapientiae  have  been  dis- 
covered at  birth,  but  at  this  period  they  exist  only  as 
mucus  papillae.] 

The  permanent  incisores  and  cuspidati,  during  their 
formation,  are  all  situated  on  the  inner  side  of  the  tempo- 
rary teeth,  consequently  they  are  contained  within  the 
segment  of  a  circle,  smaller  than  that  which  holds  the 
temporary  teeth ;  they  are  also  much  larger,  and  therefore 
very  much  crowded  and  forced  into  irregular  order. 
The  lateral  incisores  are  placed  sometimes  crossways,  and 

*  Plate  III.  f  Plate  IV.  \  Plate  V. 


PERMANENT    SET    OF    TEETH.  43 

always  behind,  in  the  space  between  the  central  incisores 
and  cuspidati.  In  the  upper  jaw  the  cuspidati  are  placed 
so  high  as  only  to  be  just  underneath  the  suborbitar 
process,  and  in  the  lower  jaw  they  are  placed  almost  as 
deep  as  the  under  margin. 

This  description  which  has  been  given  of  the  progres- 
sive steps  taken  by  nature  in  the  formation  of  the  teeth, 
may  not  exactly  agree  with  that  given  by  some  respecta- 
ble writers.  Into  Mr.  Hunter's  treatise,  for  want  of  closer 
attention,  many  inaccuracies  have  been  suffered  to  creep. 
Besides,  descriptions  of  this  kind  are  liable  to  disagree, 
because  the  formation  of  teeth  in  children  of  the  same  age 
may  be  in  a  more  or  less  advanced  state.  But  from 
various  preparations  and  observations  I  have  made,  the 
above  is  the  order  in  which  the  formation  generally  takes 
place. 


CHAPTER    THIRD. 

OF    THE    MANNER    IN    WHICH    THE    TEETH    ARE    FORMED. 

The  teeth  are  formed  in  a  manner  peculiar  to  them- 
selves, differing  from  the  mode  observed  in  the  formation 
of  bones  in  general;  instead  of  having  for  their  basis  car- 
tilage or  membranous  substance,  as  the  cylindrical  and 
flat  bones  have,  they  are  formed  from  a  soft  pulpy  sub- 
stance, which  possesses  the  shape  of  the  body  of  the 
tooth  to  be  produced. 

[The  pulp  of  a  tooth,  according  to  Mr.  Nasmyth,  is  of 
a  cellular  structure,  having  the  aspect  when  examined 
under  a  microscope,  of  small  vesicles— varying  in  size 
from  the  smallest  perceptible  microscopic  appearance,  to 
an  eighth  of  an  inch  in  diameter.  These  are  arranged 
in  layers  "  throughout  the  body  of  the  pulp."  When 
macerated,  these  layers,  says  Mr.  N.  "  present  an  irregu- 
lar reticular  appearance,"  and  are  ei  interspersed  with 
granules."] 

Each  pulp  is  covered  by  a  membrane  strongly  attached 
to  the  gum,  and  to  the  pulp  at  its  base,  so  that  the  pulp 
at  its  edge  is  loosely  contained  within  the  membrane, 
which  is  only  reflected  over  it;  at  the  base  the  pulp  is 
weakly  connected  with  the  alveolar  cavity  in  the  jaw. 

When  a  jaw  has  been  minutely  injected,  we  find  that 
the  pulps  are  vascular,  and  also  the  membranes  by  which 
they  are  enveloped      These  membranes  may  with  care 


MANNER    IN    WHICH    TEETH    ARE    FORMED.       45 

be  separated  into  two  lamella?.,  the  external  of  which  is 
rather  of  a  loose  and  spongy  texture,  and  possessed  of 
vascularity;  the  internal  lamella  is  more  smooth,  and  is 
also  vascular:  the  membranes  derive  their  vessels  from 
their  gums,  and  the  pulps  receive  theirs  from  the  artery 
which  passes  through  the  jaw. 

Some  preparations,  in  the  injection  of  which  I  have 
very  happily  succeeded,  fully  warrant  the  above  state- 
ment in  all  its  variations  from  those  of  Mr.  Hunter  or  Dr. 
Blake  the  author  of  an  inaugural  dissertation,  published 
in  Edinburg  in  1798,  containing  many  excellent  physio- 
logical remarks  on  the  formation  of  the  teeth.  Mr.  Hun- 
ter observes,  that  the  external  membrane  is  soft  and 
spongy,  without  vessels,  the  other  much  firmer,  and 
extremely  vascular.  Dr.  Blake  says,  "they  (the  mem- 
branes) can  easily  be  separated  into  two  lamellae,  the 
external  of  which  is  spongy  and  full  of  vessels;  the  inter- 
nal one  is  more  tender  and  delicate,  and  seems  to  contain 
no  vessels  capable  of  conveying  red  blood. "  In  several 
preparations  which  are  minutely  injected,  taken  from  the 
human  subject,  and  also  from  the  foetal  calf,  I  have  found 
both  the  lamellae  to  be  very  vascular.* 

The  manner  in  which  the  permanent  teeth  derive  their 
origin,  wras  never  properly  understood  until  described  by 
Dr.  Blake,  and  is  a  discovery  which  shews  very  accurate 
observation. 

[The  supposed  discovery  of  Dr.  Blake  with  regard  to 
the  manner  of  the  formation  of  the  permanent  teeth,  is 
said  to  have  been  made  twenty  years  before,  by  a  French 
dentist  by  the  name  of  Herbert.] 

When  the  rudiments  of  the  temporary  teeth  are  some- 
what advanced,  a  new  sac  is  given  off  at  the  upper  and 
posterior  part  of  their  membranes.      These  sacs  are  at 

4  Plate  X.  Fig.  },  2,  3,  1. 


46  OF    THE    MANNER    IN    WHICH 

first  contained  in  the  same  socket,  and  are  so  intimately 
connected  with  the  membranes  of  the  temporary  teeth, 
that  they  cannot  be  separated  without  tearing  one  or 
both.*  As  the  sacs  of  the  permanent  teeth  advance,  the 
sockets  of  the  temporary  ones  become  enlarged,  and  little 
niches  are  formed  in  the  internal  plate  of  the  alveolar 
processes;  these  increase  in  proportion  with  the  size  of 
the  permanent  sacs,  and  gradually  form  a  distinct  socket 
round  each  of  them. 

There  is  however  an  opening  left  immediately  under 
the  gum,  through  which  the  membranes  of  both  sets  of 
teeth  continue  to  be  connected.!  When  the  temporary 
teeth  have  risen  in  the  socket,  the  membranes  are  much 
elongated,  and  remain  attached  to  the  gum  at  the  neck  of 
the  tooth,  small  foramina  being  left  in  the  jaw  for  them  to 
pass  through;  thus  they  continue  to  derive  their  vessels 
from  the  gums.  J 

The  second  and  third  permanent  molares  are  in  like 
manner  formed  from  the  first :  a  small  process  or  sac  is 
sent  off  posteriorly,  which  is  at  first  contained  in  the 
same  socket  as  the  pulp  of  the  first  molaris;  by  degrees 
a  new  socket  is  formed  in  which  the  pulp  of  the  second 
molaris  becomes  perfect:  this  then  sends  off  another  pro- 
cess, which  forms  the  third  molaris.  || 

[The  recent  researches  of  Arnold  and  Goodsir  have 
thrown  much  new  and  valuable  light  on  the  manner  of 
the  formation  of  the  teeth.  Their  progress,  almost  from 
the  moment  of  their  appearance,  as  simple  mucous  papil- 
la?, until  the  completion  of  both  sets,  has  been  minutely 
and  accurately  traced,  by  the  last  named  gentleman,  and 
his  observations  go  to  prove  many  of  the  views  of  Dr. 
Blake  upon  this  subject  to  be  incorrect. § 

*  Plate  X.  Fig.  5.  f  Fig.  10.  \  Fig.  6.  ||  Fig.  9. 

$  Vide  Edinburg  Medical  and  Surgical  Journal  for  January,  1839. 


THE    TEETH    ARE    FORMED.  47 

Without  entering  into  a  minute  or  detailed  description 
of  the  result  of  the  researches  of  Mr.  Goodsir,  it  will  be 
sufficient  to  state,  that  the  formation  of  the  temporary 
teeth,  commences  as  early  as  the  seventh  week  after  con- 
ception. At  this  period,  the  germ  of  the  first  temporary 
molaris  of  the  upper  jaw,  may  be  seen  rising  up  from  the 
mucous  membrane  lining  the  floor,  of  what  he  denomi- 
nates the  primitive  dental  groove,  in  the  form  of  a  "  simple 
free  granular  papilla,"  of  an  "ovoidal"  shape — "the 
long  diameter  of  w7hich  is  anterio-posterior."  Another 
papilla,  of  a  rounded  and  granular  form,  between  the 
"middle  and  anterior"  curve  of  the  jaw,  on  the  floor  of 
the  same  groove,  is  observable  about  the  eighth  week. 
This  is  the  rudiment  of  the  temporary  cuspid atus.  The 
germs  of  the  incisores — the  central  first  and  then  the 
lateral,  make  their  appearance  in  the  form  of  mucous  pa- 
pillae, during  the  ninth  week.  During  the  tenth  week, 
the  sides  of  the  groove  before  and  behind  the  first  molar 
papilla,  gradually  approach  each  other,  sending  off  pro- 
cesses from  each  side,  which  meet,  and  enclose  it  in  a 
follicle.  A  similar  follicle,  in  the  mean  time,  is  gradually 
forming  around  the  germ  of  the  cuspidatus.  The  papilla 
of  the  second  temporary  molaris,  makes  its  appearance 
during  the  latter  part  of  the  tenth  week. 

The  incisor  follicles  are  formed  during  the  eleventh 
and  twelfth  weeks,  and  during  the  thirteenth  week,  a 
follicle  is  formed  for  the  papilla  of  the  second  temporary 
molaris.  Each  papilla  now  begins  to  assume  a  particular 
shape,  the  incisores  that  of  the  'future  teeth/  the  cuspi- 
dati  that  of  'simple  cones/  the  molares  'become  flattened 
transversely.'  About  this  time,  the  papillae  begin  to  grow 
faster  than  the  follicles,  and  soon  protrude  from  their 
mouths.  The  depth  of  the  follicles  varies  to  correspond 
with  the  length  of  the  fangs  of  the  future  teeth;  and  their 


48  OF    THE    MANNER    IN    WHICH 

mouths  as  they  become  more  developed,  are  formed  into 
opercula,  which,  in  some  measure,  correspond  with  the 
crowns  of  the  future  teeth.  The  incisor  follicles  have 
two  opercula — one  anterior  and  one  posterior — the  first 
larger  than  the  latter;  the  follicles  which  contain  the  cus- 
pidati  papillae,  have  three — one  external  and  two  inter- 
nal, and  the  molar  follicles,  as  many  as  there  are  tubercles 
on  the  masticating  surfaces  of  these  teeth. 

During  the  fourteenth  week,  the  lips  of  the  primitive 
dental  groove  meet  in  a  valvular  manner,  giving  to  the 
papillae  the  appearance  of  having  receded  back  into  the 
follicles,  in  wThich  they  are  nearly  hid  by  the  closing 
of  the  opercula. 

The  germs  and  follicles  of  the  lower  teeth  do  not  ap- 
pear quite  so  soon  as  those  of  the  upper,  but  in  every 
other  respect  the  manner  of  their  formation  and  their 
progress  are  almost  precisely  similar. 

At  about  the  last  mentioned  period,  provision  is  made 
for  the  production  of  the  teeth  of  replacement,  consisting 
in  the  formation  of  a  crescent-shaped  depression,  imme- 
diately behind  the  inner  opercula  of  each  follicle — first  of 
the  central  incisores,  next  of  the  lateral,  then  of  the  cus- 
pidati,  and  lastly  of  the  first  and  second  molares.  These 
cresent-shaped  depressions,  are  soon  formed  into  what 
Mr.  Goodsir  calls  "cavities  of  reserve,"  and  from  which 
the  sacs  and  pulps  of  the  ten  anterior  permanent  teeth 
are  produced. 

The  primitive  dental  groove  has  by  this  time  attained 
a  higher  level,  and  is  now  very  properly  denominated, 
by  Mr.  Goodsir,  the  secondary  dental  groove.  It  has 
now  extended  itself  back  of  the  second  temporary  mola- 
ris,  and  from  the  floor  of  which,  about  the  sixteenth  or 
seventeenth  week,  the  papilla  and  follicle  of  the  first  per- 
manent molaris  begins  to  be  developed. 


THE    TEETH    ARE    FORMED.  49 

As  the  papillae  of  the  temporary  teeth  increase  in  size, 
they  gradually  assume  the  shape  of  the  teeth  they  are 
respectively  destined  to  form.  The  pulps  of  the  upper 
molares  are  perforated  by  three  canals,  which  penetrate 
to  their  centres,  and  the  lower  by  two.  The  primary 
base  is  divided  into  an  equal  number  of  secondary  bases. 
From  these,  the  roots  of  the  future  teeth  are  formed. 
The  sacs  of  the  teeth  now  grow  more  rapidly  than  the 
pulps,  so  that  a  space  is  formed  between  them.  There 
is  deposited  in  this,  a  gelatinous  granular  substance. 
This,  at  first,  is  small  in  quantity,  and  adheres  only  to 
the  proximal  surfaces  of  the  sacs,  but  about  the  fifth 
month,  it  becomes  closely  and  intimately  attached  to  the 
whole  of  the  interior  of  these  organs,  except  for  a  small 
space  of  equal  breadth,  all  around  the  base  of  the  pulps, 
and  as  these  become  perforated  by  the  canals  just  men- 
tioned, the  granular  matter  sends  processes  into  them, 
which  adhering,  reserve  the  narrow  space  described 
above,  between  themselves  and  the  secondary  bases. 
These  processes  of  granular  matter  disappear  near  the 
point  of  junction  of  the  canals  which  enter  the  pulp. 
The  granular  matter  does  not  adhere  to  the  pulps,  but 
is  accurately  moulded  to  all  their  depressions  and 
prominences. 

The  cavities  of  reserve  gradually  recede  and  assume  a 
position  behind  the  temporary  teeth,  and  about  the  fifth 
month  the  distal  extremities  of  the  anterior  ones  begin  to 
distend,  and  give  rise  to  the  germs  of  the  replacing 
teeth,  which  soon  acquire  the  appearance  of  dental  pulps. 
About  a  month  later,  bony  septa  are  thrown  across  the 
alveolar  groove,  and  niches  formed  in  the  posterior  walls 
of  the  alveoli  for  the  sacs  of  the  permanent  teeth.  Up 
to  the  eighth,  and  sometimes  even  up  to  the  ninth  month, 
the  sacs  of  the  permanent  molares  are  embedded  in  the 


50  OF    THE    MANNER    IN    WHICH 

maxillary  tuberosity.  In  the  formation  of  the  roots  of 
the  temporary  incisores,  "three  cotemporaneous  actions/5 
says  Mr.  Goodsir,  "are  employed,  viz:  the  lengthening 
of  the  pulp ;  the  deposition  of  tooth  substance  upon  it ; 
and  the  adhesion  to  the  latter  of  that  portion  of  the  inner 
sac  which  is  opposite  to  it."  The  sacs  of  the  permanent 
.teeth  continue  to  recede  during  the  advance  of  the  tem- 
porary teeth  and  "their  sockets  to  their  perfect  state/' 
and  to  "insinuate  themselves"  "between  the  sacs  of  the 
former"  until  "they  are  only  connected  by  their  proximal 
extremities"  through  the  alveolo-dental  canals  or  itinera 
dentium,  as  they  are  termed  by  M.  Delabarre. 

From  the  foregoing  brief  summary  of  the  result  of  the 
researches  of  Mr.  Goodsir;  as  given  at  length  by  himself, 
it  will  be  perceived,  that  the  germs  of  the  permanent 
teeth,  although  like  those  of  the  temporary,  originating 
from  mucus  membrane,  are  nevertheless  of  distinct  origin, 
and  have  no  connection  with  them.  Their  origin  and 
progress,  however,  as  well  as  those  of  the  temporary, 
will  be  more  readily  and  better  understood  by  an  exami- 
nation of  plate  VII.  copied  from  the  diagram  given  by  the 
author  of  the  paper  in  question.] 

A  tooth  is  composed  of  two  substances,  one  of  which, 
called  the  enamel,  is  spread  over  that  part  which  is  not 
covered  by  the  gums.  The  other  substance  is  bone;  it 
consists  of  the  fang  and  all  the  body  of  the  tooth  situated 
within  the  enamel.  [To  these  may  be  added  the  pulp 
and  crusta  petrosa,  or  cementum.] 

[The  pulp  is  soft,  gelatinous,  and  has  a  semi-transpa- 
rent appearance;  its  surface  is  covered  by  an  extremely 
thin  and  vascular  membrane,  designated  by  Raschkow, 
the  praeformative  membrane.  This  membrane  constitutes 
the  bond  of  union  between  the  enamel  and  the  bone  of 
the  tooth.] 


THE    TEETH    A 11 E    FORMED.  51 

The  bone  of  the  tooth  is  formed  from  the  pulp,  and 
the  enamel  from  the  investing  membrane.  The  bony 
part  of  the  tooth  is  begun  to  be  formed  before  the  enam- 
el. i  When  the  ossification  of  a  tooth  is  commencing, 
bone  is  deposited  from  the  vessels  of  the  pulp  upon  its 
extreme  points.  In  the  incisores  it  begins  upon  their 
edges,  and  in  the  molares,  upon  the  points  of  their  grind- 
ing surfaces.  The  ossification  usually  begins  in  the  in- 
cisores in  three  spots;  these  increase,  soon  unite  and  pro- 
duce the  cutting  edge  of  the  tooth :  In  the  molares  it  be- 
gins in  as  many  spots  as  there  are  grinding  points,  which 
in  the  lower  jaw  are  commonly  four,  and  in  the  upper, 
five :  These  soon  unite  and  form  one  thin  layer  of  bone 
of  the  upper  surface  of  the  pulp.  The  ossification  soon 
extends  to  the  sides  of  the  pulp,  and  a  thin  shell  of  bone 
is  spread  over  its  whole  surface. * 

If  this  shell  be  removed,  the  pulp,  when  uncovered, 
will  be  found  very  vascular.  This  is  extremely  well  seen 
in  the  teeth  of  large  animals,  when  in  a  state  of  formation. 
Some  time  ago  I  had  the  opportunity  of  examining  the 
pulps  of  the  teeth  of  a  young  elephant,  which  was  dis- 
sected by  Mr.  Astley  Cooper.  Upon  removing  the  ossi- 
fication which  had  taken  place  upon  the  pulps,  I  found 
the  vessels  to  be  exceedingly  full  of  blood :  There  was 
also  a  considerable  degree  of  force  required  to  separate 
the  bone  from  the  pulp,  and  this  strength  of  union  be- 
tween the  pulp  and  the  ossified  part,  I  have  always  found 
to  be  in  proportion  to  the  size  of  the  tooth. 

In  the  formation  of  the  bone  of  a  tooth  the  ossific  mat- 
ter is  deposited  in  strata,  one  within  the  other;  thus  a 
tooth  is  formed  from  the  outer  part  to  the  inner,  and  this 
deposition  of  bone  continues  until  the  tooth  becomes 
complete.  When  the  body  of  the  tooth  is  formed,  the 
pulp  elongates,  and  takes  that  form  of  the  fang  proper  to 


52  MANNER    OF    THE 

each  particular  tooth,  and  bone  is  deposited  upon  it:  It 
then  becomes  gradually  smaller,  until  it  terminates  in  a 
point.  If  a  tooth  have  two  or  more  fangs,  the  pulp 
divides,  and  the  ossification  proceeds  accordingly.  The 
cavity  within  a  tooth,  as  it  is  forming,  is  at  first  very 
considerable;  it  becomes  less  as  the  formation  advances, 
until  it  arrives  at  a  certain  point,  when  a  cavity  is  left  in 
it  extending  nearly  through  the  whole  length,  and  re- 
taining the  shape  of  the  tooth. * 

In  the  crown  of  the  tooth,  the  cavity  is  of  the  same 
figure,  and  it  divides  into  as  many  canals  as  there  are 
fangs  to  the  teeth,  a  canal  extends  through  each  fang 
connected  with  the  cavity  in  the  body  of  the  tooth :  Into 
this  cavity  the  nerves  and  blood-vessels  enter  and  ramify 
upon  the  membrane  of  the  pulp,  which  remains  to  line 
the  cavity  after  the  formation  of  the  teeth.  In  this  man- 
ner the  nerves  give  sensation  to  the  teeth,  and  the  inter- 
nal parts  of  them  are  nourished. 

[MANNER  OF  THE  FORMATION  OF  THE  ENAMEL.] 

The  enamel  is  situated  upon  all  that  part  of  a  tooth 
which  in  the  healthy  state  of  the  gums  is  not  covered  by 
them.  This  portion  of  the  tooth  is  called  the  body,  or 
crown.  It  is  formed  by  the  membrane  which  invests 
the  pulp :  When  a  shell  of  bone  has  been  formed  upon 
the  pulp,  this  membrane  secretes  a  fluid,  from  which  a 
very  white  soft  substance  is  deposited  upon  the  bone; 
this  at  first  is  of  a  consistence  not  harder  than  chalk,  for 
it  may  be  scratched  or  scraped  off  by  the  nail;  it  how- 
ever soon  grows  hard,  and  seems  to  undergo  a  process 
similar  to  that  of  crystalization,  for  it  takes  a  regular  and 
peculiar  form. 

*  Plate  IX.  Fig.  4. 


FORMATION  OF  THE  ENAMEL.         53 

The  deposition  of  the  enamel  continues  nearly  as  long 
as  a  tooth  is  contained  within  the  membrane;  it  is  always 
most  in  quantity  upon  those  parts  where  its  formation 
first  began;  it  is  thicker  upon  the  edges  and  grinding  sur- 
faces of  the  teeth  than  upon  the  sides,  and  it  gradually 
becomes  thinner  as  it  approaches  the  necks  of  the  teeth. 
A  tooth,  when  sawn  through,  shews  the  arrangement  of 
the  enamel;  and  as  it  requires  more  heat  to  blacken  and 
burn  this  hardest  part  of  the  animal  frame  than  the  bony 
part  of  the  tooth,  we  can,  by  exposing  it  to  the  effects  of 
fire,  obtain  a  still  more  distinct  exhibition  of  it.*  By  the 
time  the  enamel  is  completely  formed,  the  tooth  has  risen 
so  much  in  the  socket,  that  by  its  pressure  it  occasions  an 
absorption  of  the  membrane,  which  completely  prevents 
any  further  addition  of  enamel. 

When  perfect,  the  enamel  of  the  teeth  is  so  hard,  that 
a  file  in  cutting  it  is  soon  worn  smooth ;  and  when  struck 
with  it,  sparks  of  fire  will  be  elicited;  an  effect  I  have 
several  times  produced  with  human  teeth,  and  which 
may  be  very  readily  seen  by  striking  the  teeth  of  large 
animals  with  steel,  particularly  those  of  the  Hippopo- 
tamus. 

The  enamel,  when  broken,  appears  to  be  composed  of 
a  great  number  of  small  fibres,  all  of  which  are  so  ar- 
ranged as  to  pass  in  a  direction  from  the  centre  to  the 
circumference  of  the  tooth,  or  to  form  a  sort  of  radii 
round  the  body  of  the  tooth.  This  is  the  crystalized 
form  it  acquires  some  time  after  its  deposit;  by  this  dis- 
position of  its  fibres,  the  enamel  acquires  a  great  degree 
of  strength,  and  thus  it  is  not  so  readily  worn  down  in 
mastication,  nor  so  easily  fractured  by  violent  action  of 
the  teeth. f 

♦Plate  IX.  Fig.  1.  t  Plate  IX.  Fig.  2,  3. 

8 


54  MANNER    OF    THE 

[The  foregoing  explanation  of  the  manner  of  the  for- 
mation of  the  enamel,  has,  until  recently,  been  regarded 
by  anatomists  and  most  writers  on  odontology,  as  correct, 
but  the  recent  researches  of  Raschkow  and  others,  have 
very  conclusively  proven  it  to  be  erroneous.  In  fact  a 
different  theory  was  promulgated  as  early  as  1819,  by 
M.  Delabarre,  in  his  treatise  on  Second  Dentition.  This 
writer  contends  that  the  enamel  is  an  integral  part  of  the 
tooth,  that  it  proceeds  from  the  dental  embryo,  and  is 
produced  by  an  immense  number  of  small  exhalent 
vessels,  which  form  a  sort  of  imperceptible  velvet.  Into 
these,  he  supposes  the  calcareous  ingredients  are  de- 
posited, and  in  such  a  way  as  not  to  destroy  their  organic 
sensibility. 

According  to  Raschkow,  the  gelatinous  granular  sub- 
stance, spoken  of  by  Goodsir,  and  situated  between  the 
follicle  and  germ  of  the  tooth,  is  the  organ  destined  for 
the  formation  of  the  enamel.  Raschkow  calls  it  the  ada- 
mantine organ,  and  says  it  forms  a  'globular  nucleus'  be- 
tween the  follicle  and  dental  germ,  at  a  very  early  period 
of  the  growth  of  the  latter,  with  a  bulging  externally, 
and  presenting  internally  a  parenchymatous  appearance, 
gradually  exhibiting  angular  granulations,  which  are  con- 
nected with  each  other,  by  'filaments  of  cellular  tissue,5 
resembling  'a  kind  of  actinenchyma,  such  as  may  be  seen 
in  plants.'  The  editor  has  frequently  had  opportunities, 
in  dissecting  the  jaws  of  young  animals,  of  demonstrating 
the  existence  of  this  granular  substance,  and  it  was  the 
discovery  of  this,  that  induced  him  to  believe  the  gene- 
rally received  opinion  of  the  manner  of  the  formation  of 
the  enamel,  to  be  erroneous.  This  granular  substance  is 
surrounded  by  a  limpid  fluid  resembling  the  liquor  amnii, 
and  as  ossification  commences  on  the  pulp  of  the  tooth, 
it  is  gradually  transformed  into  a   membrane,  attaches 


FORMATION  OF  THE  ENAMEL.         55 

itself  to  it,  and  to  which  it  adheres  with  considerable 
tenacity. 

Raschkow  says,  'the  dental  germ,  in  advancing  further 
and  further  into  the  dental  follicle,  makes  first  only  a 
slight  impression  on  the  globular  mass  of  the  enamel 
organ,  but  this  impress  is  rendered  gradually  deeper  as 
the  growth  of  the  germ  proceeds.  When  the  germ  has 
penetrated  further  into  the  hollow  thus  made,  it  appears 
narrower  towards  the  base,  and  thicker  under  the  apex, 
and  is  enclosed  around  on  every  side  by  the  parenchyma 
of  the  enamel  organ,  which  thus  assumes  the  appearance 
of  a  hood,  covering  the  dental  germ  when  advanced  in 
its  development.'  It  is  disconnected  from  the  dental 
capsule,  except  at  the  coronal  part,  where  it  is  apparently 
united  by  some  loose  vessels,  which  supplies  the  paren- 
chyma of  the  enamel  organ  with  the  numerous  capilla- 
ries that  pervade  it ;  and  from  this,  our  author  assumes, 
that  while  the  tooth  germ  originates  from  the  extremity 
of  the  sac  next  the  fang,  the  enamel  organ  has  its  origin 
from  the  opposite  extremity,  and  thus,  'arising  at  opposite 
points'  they  'approach  each  other,  are  adapted  together, 
and  both  contribute'  to  the  production  of  the  tooth.  He 
also  describes  a  peculiar  organ  on  the  inner  surface  of 
this  granular  substance,  'consisting  of  short  uniform  fibres, 
placed  perpendicularly'  'to  the  cavity,  and  forming  as  it 
were,  a  silky  lining  to  it,  which  may  readily  be  distin- 
guished in  a  transverse  section  of  the  enamel  organ,  from 
the  stellated  parenchyma'  of  this  substance,  which  he 
calls  the  pulp. 

This  stratum  of  fibres,  he  represents,  as  originating  in 
the  transformation  of  the  enamel  pulp,  with  which  it  is 
for  a  time  connected,  but  from  which  it  afterwards  sepa- 
rates, so  as  only  to  adhere  by  a  ffew  filaments  of  cellular 
tissue,   and    becomes   a    genuine  membrane.'   which    he 


56  MANNER    OF    THE 

styles,  'the  enamel  membrane.'  The  inner  surface  of 
this  membrane,  he  says,  'consists  of  hexangular,  nearly 
uniform  corpuscules,  visible  only  through  a  magnifying 
glass,  towards  the  centre  of  each  of  which,  is  a  round 
eminence.  These  corpuscules  are  nothing  more  than  the 
ends  of  short  fibres,  of  which  the  whole  membrane  is 
composed,  and  which  being  pressed  together,  assume 
freely  the  hexangular  form.'  They  are  disposed  in  regu- 
lar series,  and  correspond  with  the  arrangement  of  the 
fibres  of  the  enamel. 

These  corpuscules,  he  regards  as  secretory  ducts, 
whose  peculiar  office  is  to  secrete  the  enamel  fibres  which 
correspond  to  them.  This  process  begins  immediately 
after  the  commencement  of  the  ossification  of  the  pulp  of 
the  tooth,  and  while  it  is  going  on,  Raschkow  thinks  an 
organic  lymph  is  secreted  from  the  parenchyma  of  the 
enamel  membrane,  which  diffuses  itself  between  the  fibres, 
rendering  the  whole  substance  soft,  but  which  afterwards, 
by  means  of  a  kind  of  chemico-organic  process,  combines 
with  the  earthy  substances,  and  forms  the  animal  base  of 
the  enamel. 

The  membrane  covering  the  pulp  of  the  tooth,  he  calls 
the  praeformative,  and  this,  no  doubt,  as  has  been  before 
intimated,  constitutes  the  bond  of  union  between  the 
enamel  and  bone  of  the  tooth. 

Little  is  known  with  regard  to  the  manner  of  the  for- 
mation of  the  cementum,  or  fourth  substance  entering 
into  the  composition  of  the  tooth.  Raschkow  thinks  that 
it  may  be  produced  by  the  remains  of  the  enamel  pulp. 
I  am  of  the  opinion,  however,  that  it  is  secreted  by  the 
dental  periosteum,  and  the  more  so,  as  it  cannot  be  de- 
tected on  the  crowns  of  the  human  teeth.] 

While  some  eminent  physiologists  have  contended, 
that  the  teeth,  when  they  have  attained  their  full  growth, 


FORMATION  OF  THE  ENAMEL.         57 

are  to  be  considered  as  extraneous  bodies,  and  that  they 
no  longer  receive  nutriment,  like  the  other  bones  of  the 
body;  others  have  supposed,  that  even  the  enamel  is 
kept  up  in  future  life  by  continued  deposit :  but  that  this 
cannot  be  the  case  will  be  obvious,  when  it  is  considered, 
that  the  membrane  which  invested  the  pulp  and  entirely 
produced  the  enamel  is  destroyed  before  the  tooth  can 
appear.  When  a  tooth  first  appears,  the  enamel  is  thick- 
er than  at  any  other  period  of  life,  and  from  that  time  it 
begins  to  decrease;  this  may  be  remarked  in  some  of 
the  permanent  teeth.  The  incisores,  when  they  first 
pass  through  the  gum,  have  their  edges  notched;  the 
cuspidati  are  sharp  at  their  points,  and  the  grinding  sur- 
face of  the  molares  is  always  irregular.  This  sharpness 
of  the  points  of  the  teeth  is  occasioned  by  a  larger  de- 
posit upon  those  parts  where  ossification  had  first  com- 
menced. By  the  friction  of  the  teeth  against  each  other, 
and  against  the  food  in  mastication,  the  teeth  are  worn 
smooth,  the  notches  upon  the  incisores  disappear,  the 
points  of  the  cuspidati  are  rounded,  or  in  many  cases  en- 
tirely removed,  and  the  surfaces  of  the  molares  become 
much  smoother. 

The  case  is  quite  the  reverse  with  the  bony  part,  for 
when  a  tooth  is  first  seen  through  the  gum,  scarcely  more 
than  two-thirds  of  the  fangs  are  formed,  but  the  ossifica- 
tion continues  for  a  considerable  time  afterwards. 

The  enamel  upon  some  teeth  has  a  very  defective  for- 
mation; instead  of  being  a  hard  white  substance,  having 
a  smooth  polished  surface,  it  is  frequently  met  with  of  a 
yellow  colour,  and  having  a  great  number  of  indentations 
upon  its  surfaces.  This  occasions  the  teeth  to  resemble 
the  exterior  of  sponge,  and  gives  them  what  has  been 
termed  a  honey-combed  appearance. 

Sometimes  this  appearance  of  the  enamel  is  only  met 


58     MANNER  OF  FORMATION  OF  ENAMEL. 

with  on  the  front  teeth,  near  the  cutting  edge;  at  others 
it  extends  nearly  over  half  of  the  tooth,  the  remaining 
parts  being  perfect.  When  the  roughness  is  near  the 
edge,  it  often  wears  out  in  a  few  years,  or  at  the  age  of 
maturity  it  may  be  filed  out.  In  some,  one,  two,  or  three 
indented  lines  pass  across  the  front  of  the  teeth.* 

[The  affection  under  consideration  may  result  from  the 
destruction  of  a  portion  of  the  praeformative  membrane  or 
some  one  or  more  of  the  enamel  fibres,  caused  by  disease 
of  the  general  system,  and  some  writers  are  of  the  opinion 
that  it  is  wholly  referable  to  the  occurrence  of  eruptive 
diseases  during  the  formation  of  the  enamel.  M.  Duval 
has  given  to  the  disease  the  name  of  atrophy.] 

This  defective  formation  of  the  enamel  is  usually 
confined  to  the  incisores,  cuspidati,  and  first  permanent 
molares:  it  is  rarely  met  with  on  the  bicuspides,  or  second 
and  third  molares. — No  certain  reason  can  be  assigned 
why  the  membrane  secreting  the  enamel  should  so  often 
deviate  from  its  natural  action.  It  can  only  be  referred 
to  some  peculiarity  of  constitution,  occasioning  an  irregu- 
lar action  in  the  membranes  of  the  pulps,  during  the  first 
months;  for  this  appearance  is  only  met  with  on  those 
teeth,  the  formation  of  which  commences  about  the  time 
of  birth :  and  even  upon  them,  in  those  parts  only  which 
are  first  formed.  In  a  few  months  after,  the  membranes 
acquire  a  healthy  action,  and  the  teeth  which  are  formed 
later,  rarely  have  defective  enamel. 

It  is  very  remarkable  that  this  circumstance  often 
occurs  in  several  children  of  the  same  family ;  indeed  there 
is  scarcely  any  part  in  which  they  resemble  each  other 
more,  than  in  the  appearance  and  arrangement  of  the 
teeth.  I  have  however  constantly  observed  that  these 
kind  of  teeth  are  not  so  liable  to  decay,  as  those  which 

*  Plate  IX.  Fiff.  14. 


ARTERIES    OF  THE    TEETH.  59 

have  the  enamel  very  beautiful  and  transparent.  We 
here  find  nature,  as  she  does  in  many  other  particulars 
common  to  humanity,  making  up  for  defects  in  one  part 
of  her  work,  by  bestowing  greater  perfection  upon  an- 
other. 

[The  editor's  observations  upon  this  subject  do  not 
exactly  accord  with  the  opinion  of  Mr.  Fox.  He  has 
seldom  known  more  than  one  or  two  of  the  same  family 
to  have  their  teeth  thus  affected,  and  he  has  found  that 
atrophied  teeth  were  just  as  liable  to  decay  as  any  other, 
but  the  parts  marked  by  the  disease  are  the  portions 
least  liable  to  be  attacked  by  caries.] 

Sometimes  in  the  formation  of  the  teeth  two  pulps 
unite,  and  upon  their  surfaces,  appear  as  two  distinct 
teeth,  but  upon  attempting  to  remove  one,  it  is  discovered 
to  be  united  to  the  next.  In  Plate  IX.  are  figures  of 
several  teeth  of  this  kind,  which  must  be  regarded  as 
lusus  naturae.* 

Very  often  the  fangs  of  the  teeth  become  crooked,  from 
some  obstruction  to  their  growth;  and  teeth  having  two 
or  three  fangs,  are  now  and  then  met  with,  so  much  bent 
at  their  points  as  to  occasion  them  to  be  very  firmly  placed 
in  the  jaw.  When  these  circumstances  occur,  the  ex- 
traction of  the  teeth  is  unavoidably  an  operation  of  the 
utmost  difficulty. 

[ARTERIES    OF    THE    TEETH.] 

The  arteries  which  supply  the  teeth  with  blood,  are 
called  the  dental ;  they  are  branches  of  the  internal  max- 
illary artery,  which  arises  from  the  external  carotid,  at 
that  part  where  it  is  covered  by  the  parotid  gland,  and 
lies  behind  the  middle  of  the  upright  plate  of  the  lower 

♦Plate  IX.  Fig.  8,  9,  10. 


60  NERVES    OF    THE    TEETH. 

jaw,  where  it  divides  into  the  condyloid  and  coronoid 
processes.  It  passes  first  between  the  jaw  and  the  ex- 
ternal pterygoid  muscle,  and  afterwards  runs  in  a  very 
winding  direction  towards  the  back  part  of  the  antrum 
maxillare;  it  here  sends  numerous  branches  to  the  parts 
belonging  to  both  jaws,  and  to  the  teeth  of  the  upper  jaw. 
It  then  gives  off  one  branch  to  the  lower  jaw,  called  by 
some,  the  inferior  maxillary,  and  by  others,  the  dental. 
This  enters  the  jaw-bone  at  the  posterior  maxillary  fora- 
men, passes  through  the  maxillary  canal,  and  gives  off 
branches  to  the  fangs  of  each  tooth,  and  also  supplies  the 
substance  of  the  bone:  This  vessel  having  sent  a  branch 
to  the  incisores,  passes  out  at  the  anterior  maxillary  fora- 
men; it  is  distributed  to  the  gums,  and  communicates 
upon  the  chin  with  branches  of  the  facial  artery. 

[NERVES   OF  THE  TEETH.] 

The  nerves,  which  are  distributed  to  the  teeth,  arise 
from  the  fifth  pair,  the  trigemini.  This  pair  of  nerves 
divides  into  three  branches;  the  opthalmic,  the  superior 
maxillary,  and  the  inferior  maxillary.  The  opthalmic 
branch  passes  through  the  foramen  lacerum  of  the  orbit, 
and  is  distributed  to  the  parts  in  the  neighbourhood  of 
the  eye;  the  superior  maxillary  nerve  goes  out  at  the 
foramen  rotundum  of  the  sphenoid  bone,  and  divides  into 
several  branches,  being  continued  to  the  posterior  part  of 
the  nose,  the  palate,  velum  palati,  and  contiguous  parts. 
At  the  posterior  part,  small  filaments  of  nerves,  accom- 
panying branches  of  arteries,  enter  the  superior  maxillary 
bone  by  foramina  which  lead  to  the  molares,  and  also  to 
the  membrane  lining  the  antrum  maxillare:  The  nerve 
then  goes  into  the  canal  under  the  orbit,  and  forms  the 
infra  orbitar  nerve.     Whilst    in   the  canal,   it  sends  off 


ABSORBENTS    OF    THE    TEETH.  61 

branches  to  the  bicuspides,  cuspidati,  and  incisores;  it 
afterwards  passes  out  at  the  foramen  infra  orbitarium, 
and  is  distributed  upon  the  cheek,  under  eyelid,  upper 
lip,  and  side  of  the  nose. 

The  inferior  maxillary  nerve  passes  through  the  fora- 
men ovale  of  the  sphenoid  bone,  and  is  distributed  to  the 
muscles  of  the  lower  jaw :  it  sends  off  a  large  branch,  the 
lingual,  which  goes  to  the  tongue,  which  is  the  true 
gustatory  nerve;  it  then  enters  the  maxillary  canal  of  the 
lower  jaw,  passes  through  the  bone  under  the  alveoli, 
and  gives  off  branches,  which  entering  the  fangs,  ramify 
upon  the  membrane  within  the  cavities  of  the  teeth;  it 
passes  out  at  the  anterior  maxillary  foramen,  and  is  spent 
about  the  chin  and  lip.* 

[ABSORBENTS  OF  THE  TEETH.] 

There  is  another  set  of  vessels,  called  absorbents,  of 
the  existence  of  which,  in  the  structure  of  common  bone, 
I  believe  there  is  no  doubt;  and  on  account  of  certain 
effects  produced  upon  the  teeth,  we  must  conclude  that 
they  are  not  destitute  of  them. 

During  the  progress  of  the  second  dentition,  the  fangs 
of  the  temporary  teeth  are  absorbed;  and  even  the  per- 
manent teeth,  when  diseased,  often  lose  a  considerable 
portion  of  the  fangs.  It  may  be  argued,  that  in  these 
cases  the  absorbent  vessels  are  situated  in  the  socket,  and 
act  upon  the  tooth  as  if  it  were  an  extraneous  body. 
But  in  some  cases,  we  find  the  teeth  undergo  the  ulcera- 
tive process,  and  a  considerable  quantity  of  the  inner  part 
is  removed,  a  circumstance  wrhich  could  not  happen  un- 
less there  were  absorbents  entering  into  the  cavities  of 
the  teeth,  and  properly  belonging  to  them. 

*  Plate  IX.  Fig.  5. 

9 


62  STRUCTURE    OF    THE    TEETH. 

Besides  these  instances,  the  effects  of  absorption  in  the 
tusks  of  elephants  are  often  seen;  sometimes  in  sawing 
these  bodies,  iron  balls,  spear  heads,  &,c.  are  met  with, 
which  have  been  forced  into  them  in  attempting  to  kill 
these  animals.  These  extraneous  substances  are  always 
found  loose,  having  a  space  in  which  they  can  be  moved. 
This  could  never  happen,  unless  there  were  some  action 
going  on,  by  which  part  of  the  bone  could  be  removed, 
and  there  is  no  other  mode  in  which  it  can  be  effected, 
but  through  the  medium  of  the  absorbent  vessels. 

[As  the  editor  will  have  occasion  in  the  chapter  treat- 
ing of  the  destruction  of  the  roots  of  the  temporary  teeth, 
to  make  some  remarks  concerning  the  phenomenon  here 
alluded  to,  it  will  not  be  necessary,  in  this  place,  to  enter 
upon  its  further  explanation.] 

[ARTICULATION  OF  THE  TEETH.] 

The  teeth  are  fixed  in  their  sockets  by  that  species  of 
articulation  called  gomphosis.  They  are  attached  to  the 
alveolar  cavity  by  a  strong  periosteum,  which  is  extended 
over  the  fangs,  and  which  also  lines  the  socket;  it  is 
connected  to  the  gums  at  the  neck  of  the  tooth,  and  it  is 
vascular,  like  the  periosteum  in  other  parts  of  the  body. 

[STRUCTURE   OF  THE  TEETH.] 

It  is  very  extraordinary  that  Mr.  Hunter  should  have 
considered  the  teeth  as  devoid  of  internal  circulation,  and 
destitute  of  the  living  principle.  The  structure  of  the 
teeth  is  similar  to  that  of  any  other  bone,  and  differs  only 
in  having  a  covering  which  is  called  enamel,  for  the 
exposed  surface,  and  in  the  bony  part  being  more  dense. 
There  are  several  parts  of  the  body  in  which  we  cannot 


STRUCTURE    OF    THE    TEETH.  63 

by  injections  demonstrate  the  existence  of  blood-vessels, 
of  the  vascularity  of  which  no  one  can  entertain  a  doubt; 
and  as  bones  in  general  are  continually  receiving  nourish- 
ment from  the  vessels  which  enter  into  their  substance, 
it  may  be  justly  inferred  that  the  blood  sent  to  the  teeth 
affords  a  similar  supply,  especially  as  a  considerable 
portion  of  animal  matter  enters  into  their  composition. 

A  large  quantity  of  blood  is  distributed  to  the  teeth ; 
this  may  frequently  be  seen  in  performing  some  opera- 
tions. In  cutting  off  the  crown  of  a  tooth,  in  which  the 
caries  had  not  spread  to  the  fang,  for  the  purpose  of  en- 
grafting a  new  tooth,  I  have  several  times  seen  a  dis- 
charge of  blood  from  the  internal  cavity.  This  blood 
came  from  the  vessels  of  the  membrane  in  the  cavity, 
which  I  have  also  several  times  seen  injected.  Blood 
carries  with  it  the  basis  of  nutrition,  and  is  sent  to  those 
parts  only  where  renovation  is  necessary.  For  what 
other  reason  then,  but  to  impart  some  principle  of  nutri- 
tion, can  so  much  blood  flow  into  the  teeth?  If  the  teeth, 
after  their  first  formation,  received  no  supply  from  vessels, 
or  did  not  require  any  nourishment,  it  would  have  been 
better  if  they  had  been  destitute  of  an  internal  cavity,  and 
of  regular  organization. 

[The  vascularity  of  the  teeth  is  now  too  well  estab- 
lished to  leave  any  room  for  doubt.  The  editor  has,  in 
his  anatomical  cabinet,  sections  of  two  human  teeth,  in 
which,  by  the  aid  of  a  microscope,  vessels  injected  with 
red  blood  can  be  distinctly  traced.  A  microscopic  view 
of  one  of  these  is  given  in  the  second  volume  of  the 
American  Journal  of  Dental  Science.  The  existence  of 
vessels  in  tooth  bone  has  also  been  subsequently  demon- 
strated by  Dr.  Maynard  of  Washington  City,  and  Mr. 
Norton  of  New  York.] 

It  is  always  observed,  that  as  persons  advance  in  life, 


64  STRUCTURE    OF    THE    TEETH. 

their  teeth  lose  that  whiteness  which  they  possessed  in 
the  time  of  youth.  This  change  in  the  appearance  of 
the  teeth  seems  to  depend  upon  one  which  takes  place  in 
their  cavities,  by  which  the  vessels  entering  them  are 
gradually  destroyed,  and  the  supply  of  blood  is  propor- 
tionably  diminished.  In  the  teeth  of  persons  advanced 
in  years,  the  cavity  is  very  frequently  obliterated,  in  con- 
sequence of  a  deposit  of  bony  matter,  which  entirely  de- 
stroys the  internal  organization.  When  this  happens, 
the  teeth  always  lose  their  colour,  and  become  very 
yellow,  their  texture  also  becomes  more  brittle,  and  they 
acquire  a  horny  transparency. 

When  a  tooth  has  been  loosened  by  a  blow,  and  has 
afterwards  fastened  in  its  socket,  a  great  alteration  in  its 
colour  is  the  consequence ;  it  gradually  loses  its  white- 
ness, and  acquires  a  darker  hue;  this  proceeds  from  the 
vessels  which  enter  the  teeth,  being  destroyed,  and  the 
teeth  consequently  losing  their  supply  of  blood. 

The  teeth  being  constructed  like  common  bones,  are 
governed  by  the  same  laws,  and  are  liable  to  be  affected 
by  similar  diseases;  like  them,  they  are  affected  by  the 
various  causes  of  inflammation,  and  have  the  same  dis- 
eased appearances  produced  upon  them. 

[That  all  of  the  diseases  of  the  teeth  are  identical  with 
those  which  attack  other  bones,  is  obviously  erroneous. 
With  the  exception  of  exostosis  and  necrosis,  they  do  not 
bear  the  slightest  resemblance  to  them.  Neither  are 
they  produced  by  the  same  causes  nor  can  they  be  cured 
by  the  same  remedies.] 

In  bones,  the  power  of  resisting  the  effects  of  disease 
is  in  an  inverse  proportion  to  their  density.  The  living 
principle  is  always  less  in  the  close  textured  cylindrical 
bones,  and  greater  in  those  which  are  flat  and  spongy. 
The  teeth  being  the  most  dense  bones  in  the  body,  have 


STRUCTURE    OF    THE    TEETH.  65 

the  least  power  of  resisting  disease,  and,  in  them,  the 
general  termination  of  inflammation  is  in  mortification. 

The  teeth  do  not  possess  the  power  of  exfoliation,  it  is 
not  necessary  they  should,  for  the  system  suffers  no  in- 
jury by  the  loss  of  a  tooth :  and  no  person  would  have 
sufficient  patience  to  bear  the  pain  attending  upon,  or 
wTait  the  progress  of  so  slow  a  process.  Like  other  bones, 
the  teeth  are  subject  to  that  species  of  inflammation  called 
the  ossific,  by  which  the  fangs  become  increased  in  size, 
acquire  an  additional  quantity  of  bone,  and  exhibit  all  the 
appearances  of  exostosis.  They  are  also  liable  to  inflam- 
mation of  the  membrane  lining  the  cavity,  and  to  its  sup- 
puration, during  the  progress  of  which  the  inner  part  of 
the  tooth  is  removed  by  the  absorbents,  and  an  appear- 
ance is  produced  like  that  disease  of  bones  called  spina 
ventosa. 


CHAPTER  FOURTH. 

OF  THE  SHEDDING  OF  THE  TEETH. 

The  falling  out  of  the  temporary  teeth,  to  make  way 
for  those  which  are  to  be  permanent,  is  commonly  called 
the  shedding  of  the  teeth.  It  is  the  consequence  of  one 
of  the  most  curious  actions  of  nature,  and  is  of  great  im- 
portance to  our  comfort,  since  the  beauty  of  the  face,  and 
the  proper  articulation  of  speech  in  a  considerable  degree 
depend  upon  the  regularity  with  which  this  part  of  her 
work  is  accomplished. 

The  necessity  of  teeth  for  the  mastication  of  food  com- 
mences as  soon  as  the  time  of  support  from  the  mother 
ceases,  and  therefore  a  set  is  provided  at  a  very  early 
period,  which  occupies  but  a  few  months  in  formation, 
and  only  continues  a  few  years  without  falling  into  a  state 
of  decay.  These  teeth  are  only  proportioned  to  the  size 
of  the  mouth  during  childhood,  and  would  consequently 
be  too  small  and  too  few  in  number,  for  the  extended 
state  of  the  jaws  in  the  adult;  hence  the  formation  of  new 
teeth  becomes  indispensable,  and  according  to  the  man- 
ner already  described,  a  set  of  teeth  is  formed,  of  a  mag- 
nitude and  number  proportioned  to  the  mature  state  of 
the  body,  and  intended,  from  their  compact  structure  to 
continue  through  life.* 

*  The  same  circumstances  take  place  in  all  animals :  They,  like  the  human  sub- 
ject, shed  their  teeth,  and  obtain  a  new  set.  But  in  some  animals  there  is  a  variety 
in  the  mode,  arising  from  the  peculiar  structure  of  their  teeth  and  jaws.    This  is 


OF  THE  SHEDDING  OF  THE  TEETH.      67 

It  is  during  the  growth  of  the  permanent  teeth  that  the 
very  curious  process  of  absorption  is  going  on  in  the  tem- 
porary ones,  which  facilitates  their  removal  from  the 
socket^  and  affords  a  free  passage  to  the  permanent  teeth. 

It  has  been  observed,  that  the  pulps  of  the  new  teeth 
are  placed  behind  the  temporary  ones,  and  in  that  situa- 
tion they  are  very  much  crowded,  and  occupy  but  a  small 
space.  Now  it  is  evident  that  as  they  advance  in  growth, 
they  will  require  an  increase  of  room,  to  obtain  which 
they  must  come  forward,  so  as  to  form  a  larger  circle. 

This  effort  first  produces  a  considerable  pressure 
against  the  bony  partition,  placed  between  the  temporary 
and  permanent  teeth,  and  then  upon  the  posterior  part  of 
the  fangs  of  the  shedding  teeth.  The  pressure  in  this 
instance  acts  precisely  in  the  same  manner  as  it  generally 
does  in  other  cases  where  it  is  applied.  It  induces  an 
absorption  of  the  parts  pressed  against;  and  as  the  new 
teeth  augment,  the  fore  part  of  the  socket  which  was 
formed  around  the  pulp,  and  separated  it  from  the  tempo- 
rary tooth,  is  removed  by  the  process  of  absorption. * 
The  second  teeth  still  continuing  to  protrude,  press 
against  the  fangs  of  the  temporary  teeth,  at  which  place 
their  substance  begins  to  be  taken  up:  The  absorption 
goes  on  until  the  greater  part,  or  the  whole,  of  the  fangs 
are  removed;  at  the  same  time  the  new  teeth  come  for- 
ward, underneath  the  temporary  ones,  which  soon  drop 
out,  when  the  edges  of  the  new  teeth  may  generally  be 
distinctly  felt. 

particularly  and  very  curiously  the  case  in  the  elephant,  which  animal,  instead  of 
having  its  new  teeth  formed  under  the  temporary  ones,  they  are  formed  in  sockets 
beyond  those  to  be  shed,  which  in  due  time  advance  from  the  back  to  the  front  part 
of  the  jaw.  This  is  very  accurately  described  by  Mr.  Corse,  in  his  paper  in  the  Phil- 
osophical Transactions.  A  similar  mode  is  observed  to  take  place  in  one  grinder  of 
the  Sus  Ethiopicus,  as  described  by  Mr.  Home,  whose  paper,  with  that  of  Mr.  Corse, 
are  in  the  Transactions  for  1799. 
*Plate  II.  Fig.  1,2,3,4. 


68      OF  THE  SHEDDING  OF  THE  TEETH. 

The  absorption  gives  to  the  fangs  of  the  teeth  an  ap- 
pearance of  being  broken,  but  this,  when  compared  with 
a  fracture,  will  be  found  to  differ  from  it  very  materially. 
While  the  absorption  of  the  fangs  of  the  temporary  teeth 
seems  to  depend  so  much  on  the  pressure  of  the  rising 
permanent  ones,  it  is  often  found  to  go  on  without  such 
pressure;  for  in  some  children  the  temporary  teeth  will 
loosen  and  drop  out  many  months  before  new  teeth  ap- 
pear, and  in  many  cases  the  same  effect  takes  place  where 
a  new  tooth  does  not  rise  to  replace  the  one  which  has 
been  shed. 

These  circumstances  seem  to  prove  that  the  absorption 
of  the  fangs  of  the  temporary  teeth  is  an  action  of  nature, 
sometimes  independent  of  pressure:  and  it  is  a  very 
singular  circumstance,  that  at  a  time  of  life  when  so  great 
a  quantity  of  ossific  matter  is  poured  forth  from  all  the 
arteries  concerned  in  the  formation  of  bone,  in  one  par- 
ticular part,  there  should  thus  be  an  absorption  of  this 
substance  taking  place. 

In  many  instances,  however,  absorption  of  the  fangs  of 
the  temporary  teeth  never  takes  place;  and  it  is  by  no 
means  uncommon  to  find  one,  two,  or  sometimes  more  of 
them,  remain  in  their  sockets  for  a  great  number  of  years. 
When  this  happens  to  be  the  case  with  several  teeth,  it  is 
found  that  no  permanent  teeth  had  been  formed :  which 
shews  that  the  absorption  of  temporary  teeth,  although  a 
regular  action  in  the  animal  oeconomy,  is  very  considera- 
bly influenced  by  the  pressure  of  forming  teeth.  This 
defect  always  produces  an  unseemly  appearance,  from 
the  small  size  of  the  old  teeth,  when  compared  with  the 
new. 

Cases  of  deficiency  of  the  permanent  teeth  are  by  no 
means  unfrequent.  I  have  seen  a  young  lady  of  about 
twenty  years  of  age,  who  had  never  shed  the  two  central 


OF  THE  SHEDDING  OF  THE  TEETH.      G9 

incisores  of  the  under  jaw ;  and  in  the  upper  jaw,  all  the 
temporary  incisores  remained,  except  one  of  the  lateral, 
which  had  been  shed. 

[The  editor  cannot  believe,  that  this  curious  and  sin- 
gular operation  of  the  animal  economy  is  the  result, 
wholly,  of  the  action  of  the  absorbents.  Bourdet,  ob- 
serving a  carneous  substance  behind  the  root  of  the 
temporary  tooth,  ascribed  to  it  the  agency  of  its  destruc- 
tion, which  he  believed  to  be  effected  by  means  of  a  sol- 
vent fluid  which  it  exhales.  Laforgue  gives  to  this 
substance  the  name  of  absorbing  apparel,  believing  its 
function  to  be  the  removal  of  the  root  of  the  temporary 
tooth,  and  in  this  opinion  M.  Delabarre  concurs. 

Having  given  a  brief  exposition  of  the  last  named  au- 
thor's views  upon  this  subject,  in  his  Principles  and 
Practice  of  Dental  Surgery,  accompanied  by  his  own, 
he  will  here  repeat  what  he  there  stated.  'While  the 
crown  of  the  tooth  of  replacement,'  says  Delabarre,  'is 
only  in  formation,  the  exterior  membrane  of  the  matrix 
is  simply  crossed  by  some  blood  vessels;  but  as  soon  as  it 
is  completed,  the  capillaries  are  then  developed  in  a  very 
peculiar  manner,  and  form  a  tissue  as  fine  as  cob-web; 
from  this  tissue  the  internal  membrane,  instead  of  con- 
tinuing to  be  very  delicate,  and  of  a  pale-red  colour, 
increases  in  thickness  and  assumes  a  redder  hue.  As  was 
before  said,  it  is  at  the  instant  in  which  commences  the 
reaction  of  the  coats  of  the  matrix,  that  are  conveyed 
from  the  gum  to  the  neck  of  the  tooth,  that  the  plaiting 
of  the  vessels,  that  enter  into  their  tissue,  compose  a 
body  of  a  carneous  appearance,  whose  absorbents  extend 
their  empire  over  all  the  surrounding  parts;  it  is,  there- 
fore, the  dental  matrix  itself,  that,  after  being  dilated  to 
serve  as  a  protecting  envelope  to  the  tooth,  is  contracted 
to  form  not  only  this  bud-like  body  which  we  find  imme- 
10 


70       OF  THE  SHEDDING  OF  THE  TEETH. 

diately  below  the  milk  tooth,  at  the  instant  in  which  it 
naturally  falls  out,  and  whose  volume  is  necessarily  aug- 
mented as  odontocia  gradually  goes  on;  but  also  a  car- 
neous  mass  by  which  the  whole  is  surrounded  and  whose 
thickness  is  the  more  remarkable  as  the  organ  that  it 
envelopes  is  nearer  its  orifice.' 

After  giving  this  description  he  asks,  'is  there  a  dis- 
solving fluid  that  acts  chemically  on  the  surrounding 
parts,  or  do  the  absorbents,  without  any  intermedial, 
destroy  every  thing  that  would  obstruct  the  shooting  up 
of  the  tooth?'  In  reply  to  this,  he  says,  'Not  possessing 
positive  proof,  suitable  to  guide  me  in  the  decision  of 
this  question,  and  finding  those  of  others  of  little  import- 
ance, I  shall  not  attempt  to  answer  them.' 

In  pursuing  the  subject  further,  he  states  that  the  ves- 
sels of  the  temporary  tooth  often  remain  entire  in  the 
midst  of  this  carneous  substance,  and  continue  to  convey 
their  fluids  to  the  central  part  of  the  tooth,  whilst  the  cal- 
careous ingredients  and  the  gelatine  have  been  removed, 
and  that  at  other  times  they  too  are  destroyed.  And  the 
conclusion  to  which  he  arrives,  after  a  careful  examina- 
tion of  the  whole  subject,  is,  that  whether  the  earthy 
and  animal  parts  of  the  root  are  removed  by  the  absorb- 
ents of  the  carneous  tubercle  in  question,  without  any 
previous  change,  or  whether  they  are  decomposed  by 
the  chemical  action  of  a  fluid  exhaled  from  it,  they  are 
ultimately  carried  back  into  the  general  circulating  system. 

In  proof  of  the  agency  of  the  fleshy  tubercle  in  the 
destruction  of  the  roots  of  the  temporary  teeth,  he  men- 
tions one  fact  that  goes  very  far  to  establish  it,  and  if  his 
views  be  correct,  will  account  for  those  cases  which  are 
occasionally  met  with,  where  one  or  more  of  the  perma- 
nent teeth  fail  to  appear.  It  is  this:  if  this  substance 
fails  to  be  developed,  or  is  destroyed  by  an   injurious 


OF  THE  SHEDDING  OF  THE  TEETH.      71 

operation,  the  tooth  often  remains  in  its  socket,  and 
never  makes  its  appearance.  Cases  of  this  kind  have 
fallen  under  the  notice  of  almost  every  practitioner. 

In  as  few  words  as  possible,  I  have  given  the  views  of 
this  ingenious  writer,  on  the  subject  under  consideration, 
and  although  they  do  not  seem  to  have  attracted  much 
attention  from  English  writers,  and  are  rejected  by  Mr. 
Bell,  on  the  ground,  as  he  says,  but  which  I  have  never 
known  to  be  the  case,  that  the  destruction  of  the  root  of 
the  temporary  frequently  commences  on  a  part  Hhe  most 
remote  from  the  sac  of  the  permanent  tooth,'  I  am  dis- 
posed to  believe  them,  for  the  most  part,  correct.  As  to 
the  existence  of  the  fleshy  tubercle,  there  can  be  no 
question,  and  that  it  is  through  the  agency  of  these  that 
the  roots  of  the  temporary  teeth  are  destroyed,  seems 
more  than  probable.  But  whether  it  is  through  the 
agency  of  their  absorbent  vessels  or  a  chemical  fluid  ex- 
haled for  the  purpose,  may  not,  as  Delabarre  says,  be  so 
easy  to  determine. 

The  change  that  takes  place  in  the  external  membrane 
of  the  dental  sac,  as  noticed  by  Delabarre,  is  observable 
first  on  the  peduncle  or  chord  leading  from  it  to  the  gum 
behind  the  temporary  tooth.  It  here  becomes  thickened 
about  the  time  the  root  of  the  new  tooth  begins  to  form, 
and  assumes  a  fleshy  appearance,  and  it  is  here  that  the 
destruction  of  the  surrounding  bone  commences,  enlarg- 
ing the  alveolo-dental  canal,  and  gradually  removing  the 
intervening  long  partition,  and  finally  the  root  of  the 
temporary  tooth.  The  agency  of  this  thickened  and 
fleshy  condition  of  the  exterior  membrane  of  the  dental 
capsules,  in  the  removal  of  the  roots  of  the  temporary 
teeth,  is  rendered  more  conclusive  by  the  fact,  that,  in 
those  cases  where  the  roots  of  the  permanent  teeth  have 
become  partially  destroyed,  the  alveolo-dental  periosteum 


72      OF  THE  SHEDDING  OF  THE  TEETH. 

had  assumed  a  similar  appearance.  In  the  formation  too 
of  alveolar  abscess,  the  tubercle  at  the  extremity  of  the 
root  presents  a  like  aspect. 

It  oftentimes  happens,  that  the  root  of  a  temporary 
tooth  fails  to  be  destroyed,  and  that  the  crown  of  the 
replacing  organ  comes  through  the  gum  in  a  wrong 
place.  Whenever  this  happens,  the  carneous  body  is 
developed  only  beneath  the  parts  through  the  opening  of 
which  the  new  has  appeared,  and  is  not  brought  in  con- 
tact with  the  bony  partition  between  it  and  the  root  of 
the  temporary. 

The  manner  of  the  destruction  of  the  roots  of  the 
temporary  teeth  has  been  a  subject  of  close  and  critical 
enquiry  with  me  for  several  years,  and  the  more  I  have 
examined  it,  the  more  fully  have  I  become  convinced, 
that  it  is  the  result  of  the  action  of  this  fleshy  tubercle 
upon  them,  and  while  its  formation  seems  to  be  the 
result  of  the  contraction  of  the  dental  sac  and  its  appen- 
dage, for  the  purpose  of  effecting  the  eruption  of  the 
tooth,  it  is  especially  charged  with  the  removal  of  every 
thing  that  would  obstruct  its  passage. 

In  conclusion,  it  is  only  necessary  to  observe,  that  the 
temporary  teeth  are  shed  in  the  same  order  in  which 
they  at  first  appear.  After  one  pair  has  been  shed,  a 
sufficient  time  usually  elapses  before  the  shedding  of 
another,  for  those  of  the  same  class  of  the  permanent  set 
to  come  forward  and  take  their  place.  Thus,  the  jaws 
are  never  deprived,  unless  from  some  other  cause  than 
the  destruction  of  the  roots  of  the  temporary  teeth,  of 
more  than  two  teeth  in  each  jaw  at  any  one  time.] 

It  frequently  happens  in  the  upper  jaw,  that  the  per- 
manent central  incisores  only  are  formed,  the  lateral  ones 
never  appearing.  Many  persons  are  deficient  in  one  or 
more  of  the  bicuspides.     I  know  a  gentleman  who  re- 


OF  THE  SHEDDING  OF  THE  TEETH.      73 

sides  at  Bath,  who  has  never  had  the  incisores  of  the 
under  jaw ;  and  it  is  remarkable,  that  two  other  persons 
of  his  family  are  in  the  same  situation.  I  have  seen  a 
lady  who  had  only  four  teeth  of  the  permanent  set  in 
each  jaw.  Mr.  Taunton,  Surgeon  of  the  City  Dispen- 
sary, has  the  preparation  of  a  child's  head,  in  the  upper 
jaw  of  which  only  one  incisor  was  forming.*  These  de- 
viations often  occur  in  the  human  subject;  but  so  far  as 
I  have  observed,  they  are  very  rare  in  animals,  yet  I 
once  saw  a  horse  rising  between  eight  and  nine  years, 
which  still  retained  one  of  the  milk  incisores. 

The  appearance  of  the  fangs  of  the  teeth,  when  ab- 
sorbed, has  given  rise  to  a  popular  but  erroneous  opinion, 
that  the  first  teeth  have  no  fangs,  and  this  was  even 
taught  by  some  of  the  old  anatomists.  It  has  also  been 
erroneously  conceived  that  the  temporary  teeth  are 
pushed  out  by  the  permanent:  Now  that  this  cannot  take 
place,  will  be  seen  by  observing  the  state  of  the  two  sets 
of  teeth.  The  temporary  ones  are  firmly  placed  in  sock- 
ets, whilst  the  new  teeth,  during  their  formation,  are  con- 
tained in  cavities  larger  than  themselves,  and  can  only 
make  such  pressure  as  their  gradual  growth  will  permit. 
On  this  account,  if  the  absorption  of  the  old  tooth  be  re- 
tarded, or  the  formation  of  the  new  tooth  proceed  too 
quickly,  the  latter  will  take  an  improper  direction  when 
they  come  through  the  gums,  and  form  a  second  row  of 
teeth,  from  the  temporary  teeth  still  remaining.  More- 
over, if  the  old  teeth  were  pushed  out  by  the  new,  we 
should  always  find  those  teeth  about  to  be  displaced, 
forced  out  the  line  of  the  others,  a  circumstance  which 
never  occurs. 

The  period  at  which  children  begin  to  shed  their  teeth 
varies  considerably.     In  some,  the  teeth  become  loose  as 

•Plate  XI.  Fiff.  6. 


74       OF  THE  SHEDDING  OF  THE  TEETH. 

early  as  five  or  six  years  of  age;  in  others,  this  process 
does  not  begin  until  the  eighth  year:  about  six  or  seven 
years  of  age  may  be  taken  as  the  standard  time. 

The  teeth  of  the  permanent  set,  which  usually  appear 
first,  are  the  anterior  molares,  which  being  somewhat 
more  early  in  their  formation,  generally  precede  the  in- 
cisores; and  we  must  always  expect,  soon  after  the  cut- 
ting of  one  or  other  of  these  teeth,  that  the  shedding  of 
the  temporary  teeth  will  begin. 

Soon  after  the  first  permanent  molares  have  appeared, 
the  two  central  incisores  of  the  under  jaw  become  loose, 
and  when  they  are  but  slightly  attached  to  the  gum, 
easily  come  away;  the  permanent  central  incisores  soon 
after  appear,  one  coming  a  little  time  before  the  other;  in 
about  two  or  three  months  the  central  permanent  inci- 
sores of  the  upper  jaw  become  loose,  and  having  dropt 
out,  the  permanent  central  incisores  succeed  them. 

In  about  three  or  four  months  more,  the  under  lateral 
incisores,  having  lost  their  fangs,  come  away,  and  the 
permanent  lateral  incisores  succeed  them.  The  lateral 
incisores  of  the  upper  jaw  are  the  next  which  drop  out, 
and  the  permanent  ones  appear  shortly  afterwards.  In 
about  six  or  twelve  months  more,  the  temporary  molares 
begin  to  loosen ;  they  generally  come  out  before  the  cus- 
pidati,  the  long  fangs  of  which  take  a  much  longer  time 
in  being  absorbed. 

The  first  bicuspides  take  the  place  of  the  first  molares, 
and  about  the  time  they  appear,  the  second  temporary 
molares,  and  the  temporary  cuspidati,  become  loose,  and 
having  been  shed,  are  succeeded  by  the  permanent  cus- 
pidati, and  the  second  bicuspides. 

The  shedding  of  the  teeth,  commencing  at  six  or  seven 
years  of  age,  is  commonly  completed  in  about  hve  or  six 
years,  wThen  all  the  temporary  have  come  out,  and  those 


OF  THE  SHEDDING  OF  THE  TEETH.      75 

of  the  permanent  set  as  far  as  the  second  molares,  have 
taken  their  stations.  There  yet  remain,  to  complete  the 
set,  the  third  molares,  or  dentes  sapientiae,  and  these  usu- 
ally appear  between  eighteen  and  twenty-one  years  of 
age,  but  sometimes  they  do  not  come  till  much  later;  not 
before  twenty-seven  or  thirty  years;  and  I  once  was  con- 
sulted by  a  gentleman,  fifty  years  of  age,  who  had  great 
pain  cutting  one  of  these  teeth. 

[The  periods  for  the  eruption  of  the  permanent  teeth 
are,  like  those  of  the  temporary,  exceedingly  variable. 
The  following,  however,  may  be  regarded  as  very  nearly 
correct.  The  first  molares  usually  come  through  the 
gums  between  the  fifth  and  sixth  year;  the  central  inci- 
sores,  between  the  sixth  and  eighth ;  the  lateral  incisores, 
between  the  seventh  and  ninth;  the  first  bicuspides,  be- 
tween the  ninth  and  tenth;  the  second,  between  the  tenth 
and  eleventh,  or  eleventh  and  a  half;  the  cuspidati,  be- 
tween the  eleventh  and  twelfth ;  the  second  molares,  be- 
tween the  twelfth  and  fourteenth;  and  the  dentes  sapi- 
ential, between  the  eighteenth  and  twentieth.] 


CHAPTER  FIFTH. 

OF  THE  IRREGULARITY  OF  THE  TEETH. 

During  the  shedding  of  the  teeth  there  are  several 
circumstances  which  prevent  the  permanent  teeth  from 
acquiring  a  regular  position,  and  often  give  rise  to  very 
great  irregularity  in  their  arrangement. 

The  most  frequent  cause  is  a  want  of  simultaneous 
action  between  the  increase  of  the  permanent  teeth,  and 
the  decrease  of  the  temporary  ones,  by  the  absorption  of 
their  fangs.  It  rarely  happens  that  so  much  of  the  fang 
of  a  temporary  tooth  is  absorbed  as  to  permit  its  removal 
by  the  efforts  of  the  child,  before  the  permanent  tooth  is 
ready  to  pass  through :  on  which  account  the  new  tooth 
takes  an  improper  direction,  and  generally  comes  through 
on  the  inside. 

Cases  are  very  frequent  in  which  scarcely  any  absorp- 
tion of  the  fangs  of  the  temporary  teeth  had  taken  place 
previous  to  the  appearance  of  several  of  the  permanent 
teeth ;  and  it  often  happens,  that  upon  the  removal  of  the 
shedding  teeth  to  give  room  for  the  permanent  ones,  that 
no  absorption  of  the  fangs  of  the  temporary  teeth  has 
taken  place. 

Irregularity  of  the  permanent  teeth  is  most  commonly 
occasioned  by  the  resistance  made  by  the  nearest  tempo- 
rary teeth ;  this  is  always  the  case  if  the  temporary  teeth 
are  small  and  close  set,  for  as  the  permanent  incisores  are 


OF  THE  IRREGULARITY  OF  THE  TEETH.    77 

much  larger  than  the  temporary,  they  require  more  room ; 
but  as  the  space  left  by  the  shedding  of  the  temporary 
teeth  is  too  small  for  the  regular  position  of  the  permanent, 
they  are  exposed  to  the  pressure  of  the  next  tooth,  and 
hence  are  frequently  turned  out  of  their  right  direction. 

Another  cause  of  the  irregularity  of  the  teeth  arises 
from  the  permanent  teeth  being  too  large  for  the  space 
occupied  by  the  temporary  ones;  those  parts  of  the  jaws 
not  being  sufficiently  extended  to  permit  a  regular  posi- 
tion of  the  new  teeth — in  this  case  the  irregularity  is  con- 
siderable, and  occasions  great  deformity  in  the  appearance 
of  the  mouth.  The  incisores  and  cuspidati  being  much 
larger  than  those  of  the  child,  require  more  room,  for 
want  of  which  they  are  turned  out  of  their  proper  positions. 
The  central  incisores  overlap  each  other — the  lateral  in- 
cisores are  either  placed  obliquely  with  their  edges  turned 
forwards,  or  they  are  pushed  back,  and  stand  between 
and  behind  the  central  incisores  and  the  cuspidati;  the 
cuspidati  are  projected,  occasioning  the  lip  to  stand  out 
with  considerable  prominence,  and  the  bicuspides  are 
placed  very  irregularly. 

[Malconformation  of  the  jaws  may  be  mentioned  as 
another  cause  of  irregularity.  The  superior  alveolar 
arch  is  sometimes  too  narrow — having  a  compressed  ap- 
pearance, and  projecting  so  as  to  prevent  the  upper  lip 
from  covering  the  front  teeth.  The  arch  at  other  times  is 
too  broad,  giving  to  the  roof  of  the  mouth  a  flattened  ap- 
pearance, and  causing  the  teeth  to  be  separated  from  each 
other.  The  effect  upon  the  appearance  of  the  individual 
in  either  of  these  cases,  is  bad,  but  worse  in  the  first 
than  the  last.  The  lower  jaw  is  liable  to  similar  faulty 
configurations. 

The  disposition  to  defects  such  as  these,  is  observable 
in  early  childhood,  and  is  regarded  by  most  of  those  who 
11 


78  ACCRETION    OF   THE    JAWS 

have  treated  of  it,  as  hereditary,  and  more  peculiar  to 
the  people  of  some  countries  than  others.  Some  at- 
tribute it  to  a  rickety  diathesis  of  the  general  system,  but 
this  opinion  is  gratuitous,  as  is  shown  by  the  fact,  that 
most  persons  labouring  under  this  affection,  have  good 
palates  and  well  developed  jaws.  It  cannot,  therefore, 
with  any  degree  of  propriety  be  regarded  as  having  any 
agency  in  the  production  of  a  faulty  configuration  of  the 
jaws. 

There  is  also  another  species  of  deformity  sometimes 
met  with  in  the  upper  jaw,  equally  difficult  of  explana- 
tion. It  is  characterized  by  one  or  more  divisions  of  the 
upper  lip,  alveolar  border,  and  palatine  arch,  always  giv- 
ing rise  to  irregularity  in  the  arrangement  of  the  teeth. 
This  description  of  malconfiguration  is  congenital. 

Supernumerary  teeth  too,  may  be  reckoned  among  the 
causes  of  irregularity.  But  examples  of  this  are  of  com- 
paratively rare  occurrence.] 

It  will  be  proper,  in  this  place,  to  observe  the  manner 
in  which  the  jaw  bones  grow,  (the  under  one  being 
taken  as  the  example)  and  to  point  out  the  difference 
between  the  temporary  and  permanent  teeth. 

[ACCRETION  OF  THE  JAWS.] 

After  a  child  has  obtained  all  the  temporary  teeth,  the 
jaw  in  general  grows  very  little,  in  the  part  which  they 
occupy.  In  those  children  who  are  an  exception  to  this 
rule,  the  temporary  teeth  become  a  good  deal  separated 
from  each  other,  and  these  are  the  cases  in  which  the 
shedding  of  the  teeth  is  effected  without  any  assistance 
of  art. 

When  the  jaw  of  a  child  is  compared  with  that  of  an 
adult,  very  striking  difference  is  observed;  that  of  a  child 


ACCRETION    OF    THE    JAWS.  79 

forms  nearly  the  half  of  a  circle,  while  that  of  an  adult 
is  the  half  of  a  long  ellipsis.  This  comparison  clearly 
points  out  the  part  in  which  the  jaw  receives  its  greatest 
increase,  to  be  between  the  second  temporary  molaris 
and  the  coronoid  process;  and  this  lengthened  part  of 
the  jaw  is  destined  to  be  the  situation  of  the  permanent 
molares. 

By  the  elongation  of  the  jaw  a  great  change  in  the 
form  of  the  face  is  produced;  that  of  a  child  is  round, 
the  cheeks  are  plump  and  the  chin  flat;  in  an  adult  the 
face  is  more  prominent,  with  a  flatness  of  cheek  and  a 
considerable  length  of  chin. 

The  temporary  incisores  and  cuspidati  are  much  smaller 
than  the  permanent,  while  the  molares  of  the  temporary 
set  are  larger  than  the  bicuspides  which  succeed  them. 
Hence  it  is,  that  the  incisores  and  cuspidati  are  so  fre- 
quently irregular,  and  they  never  could  be  otherwise 
were  it  not  that  some  space  were  gained  from  the  mo- 
lares, in  consequence  of  the  bicuspides  being  much 
smaller. 

This  circumstance  is  rendered  intelligible,  by  exam- 
ining jaws  at  various  ages,  and  observing  in  wThat  particu- 
lars they  differ  from  each  other. 

Until  about  twelve  months  after  birth,  the  jaw  grows 
uniformly  in  all  its  parts,  and  at  that  time  as  far  as  the 
teeth  extend,  it  approaches  nearly  to  a  semicircle;  at 
about  three  years  of  age,  wThen  all  the  temporary  teeth 
have  appeared,  it  begins  to  lose  its  semicircular  form,  and 
become  somewhat  elongated;  an  extension  takes  place 
between  the  last  temporary  molaris  and  the  coronoid  pro- 
cess; and  in  that  part,  in  an  advanced  state  of  formation, 
the  first  permanent  molaris  will  be  found. 

At  about  seven  or  eight  years  of  age,  the  jaw  is  more 
extended,  the  first  permanent  molaris  has  grown  up,  and 


80  ACCRETION    OF    THE    JAWS. 

the  second  is  advancing  in  formation.  At  about  eleven 
or  twelve  years  of  age  it  will  be  found  still  longer;  the 
second  molaris  is  ready  to  come  through  the  gum;  and 
the  third  molaris  has  begun  to  form. 

The  jaw  acquires  its  full  proportion,  at  about  eighteen 
or  twenty  years  of  age,  when  the  third  molaris  makes  its 
appearance,  and  the  teeth  are  seen  in  the  figure  of  their 
arrangement  to  form  part  of  an  ellipsis. 

The  growth  of  the  jaw  being  nearly  confined  to  the 
part  situated  behind  the  temporary  teeth,  where  the  per- 
manent molares  are  placed,  the  anterior  part  of  the  jaw 
undergoes  little  more  than  an  alteration  in  form ;  it  adapts 
itself  to  the  permanent  teeth  there  situated,  and  scarcely 
receives  any  increase  of  size. 

The  same  comparison  of  jaws  exhibits  the  cause  of  ir- 
regularity in  the  permanent  incisores  and  cuspidati. 
When  a  child  is  about  to  shed  its  teeth,  the  first  perma- 
nent molares  come  through  the  gums  behind  the  tempo- 
rary molares,  and  therefore  the  teeth  which  are  situated 
anteriorly  to  the  permanent  molares,  can  obtain  no  ad- 
ditional space. 

The  permanent  incisores  occupy  the  space  of  the  tem- 
porary incisores,  and  half  of  that  of  the  cuspidati.  It 
commonly  happens  that  the  bicuspides  are  earlier  in  their 
appearance  than  the  cuspidati ;  therefore,  when  the  first 
temporary  molares  are  shed,  a  little  room  is  gained,  as 
the  teeth  which  succeed  them  are  smaller.  When  the 
second  molares  are  shed,  still  more  room  is  gained;  the 
two  bicuspides  go  back  against  the  first  permanent 
molares,  and  thereby  give  sufficient  room  for  the  cuspi- 
dati. Thus,  by  the  change  of  the  molares  of  the  child, 
which  are  large,  for  the  bicuspides  of  the  adult,  which 
are  small,  room  is  obtained  for  the  increased  size  of  the 
permanent  incisores  and  cuspidati. 


ACCRETION    OF    THE    JAWS.  81 

[There  exists  considerable  diversity  of  opinion  with 
regard  to  the  increase  of  that  portion  of  the  jaw  occu- 
pied by  the  temporary  teeth.  Some  writers  contend 
that  it  continues  to  grow  until  these  teeth  are  replaced 
by  the  permanent  ones,  while  others  assert  that  the  in- 
crease, after  the  completion  of  first  dentition,  is  wholly 
confined  to  the  back  part  of  the  jaw,  between  the  second 
molares  and  the  coronoid  processes,  and  that  the  ante- 
rior portion  undergoes  no  increase  whatever.  Among 
the  former  is  M.  Delabarre.  This  writer  endeavours  to 
prove  that  a  very  considerable  increase  takes  place  in  this 
part  of  the  jaw,  but  Mr.  Fox  entertains  a  different  opin- 
ion, as  may  be  perceived  from  what  he  has  said  upon  the 
subject,  and  he  endeavours  to  establish  the  correctness  of 
his  views  by  the  measurement  of  several  jaws,  as  may  be 
seen  by  reference  to  Plate  XI.  Fig.  5.  But  the  only  way 
to  arrive  at  the  truth  of  the  matter  is,  to  measure  the 
same  jaw  at  different  ages,  as  proposed  by  Mr.  Thomas 
Bell.  For  example,  let  that  portion  of  the  jaw  of  a 
child,  containing  the  temporary  teeth,  be  measured  im- 
mediately after  the  completion  of  this  dentition,  or  say 
the  third  year,  and  then  after  they  are  replaced  with  the 
permanent  teeth.  If  this  be  done,  the  portion  of  the 
jaw  occupied  by  these  teeth  will  be  found  to  have  in- 
creased a  little,  but  not  as  much  as  Delabarre  supposes. 
I  allude  to  the  change  which  takes  place  in  the  span 
or  extent  of  the  circle  of  the  arch,  not  to  the  trans- 
verse or  perpendicular  dimensions  of  the  bone.  These 
continue  to  augment  until  the  sixteenth  or  twentieth 
year.  The  premature  loss  of  a  temporary  tooth,  may, 
by  the  approximation  of  the  adjoining  teeth,  cause  a 
diminution  of  the  span  of  the  anterior  portion  of  the 
jaw.  For  this  reason  the  temporary  teeth  should  never 
be  extracted,  except  when  called  for  by  urgent  necessity. 


82  ACCRETION    OF    THE    JAWS. 

The  popular  opinion,  that  inasmuch  as  the  temporary 
teeth  are  soon  to  be  replaced,  it  is  of  little  consequence 
whether  they  be  retained  in  the  jaw  until  they  are  re- 
moved by  the  operations  of  the  economy,  or  are  lost  a 
few  years  earlier,  is  erroneous,  and  has  been  productive 
of  a  vast  amount  of  injury.] 

This  change  of  small  teeth  for  larger,  and  of  larger  for 
smaller,  points  out  the  necessity  of  giving  some  assistance 
to  nature  in  one  of  her  processes,  viz :  that  of  throwing 
out  the  temporary  teeth  before  the  permanent  teeth  ap- 
pear: if  this  be  done  at  a  proper  time,  the  teeth  will 
always  take  a  regular  position,  and  every  deformity 
arising  from  irregularity  be  prevented. 

During  the  progress  of  the  second  dentition,  an  oppor- 
tunity presents  itself  for  effecting  this  desirable  object; 
but  every  thing  depends  upon  a  correct  knowledge  of  the 
time  when  a  tooth  requires  to  be  extracted,  and  also  of 
the  particular  tooth;  for  often  more  injury  is  occasioned 
by  the  removal  of  a  tooth  too  early,  than  if  it  be  left  a 
little  too  long;  because  a  new  tooth,  which  has  too  much 
room  long  before  it  is  required,  will  sometimes  take  a  di- 
rection more  difficult  to  alter,  than  a  slight  irregularity 
occasioned  by  an  obstruction  of  short  duration.  If  an  im- 
proper tooth  be  extracted  irreparable  mischief  will  ensue; 
as  in  the  case  where  young  permanent  teeth  have  been 
removed,  instead  of  the  obstructing  temporary  ones,  which 
I  have  several  times  knowrn  to  have  been  done. 


CHAPTER  SIXTH. 

OF  THE  TREATMENT  TO  PREVENT  IRREGULARITY  OF  THE  TEETH. 

The  advantage  which  attends  the  removing  the  teeth 
of  children,  depends  upon  its  being  done  at  the  precise 
time  when  nature  is  tardy  in  effecting  the  absorption  of 
the  fangs  of  the  temporary  teeth.  The  performance  of 
any  improper  operation  will  be  prevented  by  a  knowledge 
of  the  progress  of  the  formation  of  the  teeth,  combined 
with  observations  upon  the  appearance  of  the  gums,  which 
become  full  when  a  tooth  is  about  to  pass  through  them. 

To  assist  the  permanent  teeth  in  acquiring  their  proper 
arrangement,  the  mouth  should  be  examined  from  time  to 
time,  that  the  operation  be  performed  at  the  time  re- 
quired; for  it  is  not  sufficient  to  remove  an  obstructing 
tooth,  when  the  new  one  is  perceived  to  be  coming  irreg- 
ularly, because  it  always  requires  a  considerable  time  to 
bring  the  latter  into  its  proper  place,  and  often  the  ir- 
regularity remains  unaltered. 

The  shedding  of  the  teeth  commonly  begins  at  about 
seven  years  of  age :  sometimes  it  may  be  earlier,  and  at 
others  rather  later;  however,  it  is  about  this  time  that  a 
child's  mouth  begins  to  require  frequent  inspection. 

There  are  two  circumstances,  the  presence  of  either  of 
which  always  denotes  that  the  shedding  of  the  teeth  is 
about  to  commence.  The  first  permanent  molares  of  the 
under  jaw  make  their  appearance;  or  one  or  both  of  the 
central  incisores  in  the  under  jaw  begin  to  loosen. 


84       OF  THE  TREATMENT  TO  PREVENT 

Sometimes  the  absorption  of  the  fangs  of  the  temporary 
teeth  goes  on  so  slowly,  that  they  do  not  get  loose  pre- 
vious to  the  passing  of  the  new  tooth  through  the  gums 
behind  them.  If  then  the  permanent  molares  have  been 
cut  for  some  time,  and  there  be  a  fulness  of  the  gums  be- 
hind the  under  permanent  incisores,  it  will  be  expedient 
that  the  two  central  incisores  be  extracted  immediately  3 
although  not  yet  loose.  It  most  commonly  happens  that 
the  under  central  incisores,  by  the  early  absorption  of 
their  fangs,  becomes  loose,  and  are  taken  out  by  the  child 
some  time  previous  to  the  appearance  of  the  new  teeth; 
but  it  often  occurs,  that  although  they  have  got  somewhat 
loose,  they  are  not  sufficiently  so,  to  come  out  of  them- 
selves before  the  new  teeth  are  ready  to  pass  through. 
When  in  this  state,  the  temporary  central  incisores  should 
be  removed,  and  this  will  permit  the  permanent  central 
incisores  to  take  their  proper  place.  It  will  soon  be  seen, 
as  the  new  teeth  arise,  whether  they  have  sufficient  room; 
if  not,  it  will  be  necessary  to  remove  the  temporary  lateral 
incisores. 

In  two  or  three  months  afterwards,  or  sometimes  later, 
attention  must  be  paid  to  the  central  incisores  of  the  up- 
per jaw.  If  they  have  got  loose  they  should  be  taken 
out,  or  if  not,  and  there  be  the  least  fulness  of  the  gums 
behind  them,  they  must  be  extracted,  or  else  one  or  both 
of  the  permanent  incisores  will  come  through,  and  pro- 
duce one  of  the  most  unseemly  cases  of  irregularity,  as 
well  as  one  of  the  most  difficult  to  treat. 

When  the  permanent  central  incisores  are  passing 
through  the  gum,  there  is  seldom  sufficient  room  for 
them,  and  it  will  be  proper  to  extract  the  temporary 
lateral  incisores. 

[The  author  seems  to  have  overlooked  the  fact,  that, 
by  the  time  the  upper  permanent  central  incisores  are 


IRREGULARITY    OF    THE    TEETH.  85 

ready  to  come  through  the  gums,  the  temporary  lateral 
incisores  have  become  so  much  loosened  by  the  wasting 
of  their  roots,  as  to  yield  sufficiently  to  the  pressure  of 
the  former  to  permit  these  teeth  to  take  their  proper 
place  in  the  arch.  But  when  this  is  not  the  case,  the 
temporary  lateral  incisores  should  be  extracted.] 

The  attention  is  next  to  be  turned  to  the  under  jaw, 
for  in  three^  or  six  months  time,  the  lateral  permanent 
incisores  may  be  expected  to  appear,  and  if  there  be  any 
fulness  of  the  gum,  where  those  teeth  are  to  pass,  the 
temporary  cuspidati  must  be  taken  out.  In  two  or  three 
months  more  the  same  observations  should  be  made  upon 
the  upper  jaw,  and  as  soon  as  the  permanent  lateral  in- 
cisores exhibit  signs  of  approach,  by  a  fulness  of  the 
gums,  the  temporary  cuspidati  should  be  extracted. 

When  the  teeth  are  in  this  state,  they  may  often  re- 
main without  farther  attention  for  near  a  twelve-month, 
during  which  time  the  incisores  will  be  acquiring  their 
complete  growth;  and  the  cuspidati  and  the  bicuspides 
be  ready  to  come  through.  Care  must  now  be  taken 
that  the  permanent  cuspidati  do  not  take  an  improper 
direction;  the  gums  should  be  examined,  and  if  any 
prominence  be  felt,  the  first  temporary  molares  must  be 
extracted.  It  frequently  happens  that  the  first  tempo- 
rary molares  get  loose  previous  to  any  appearance  of  the 
cuspidati,  and  that  when  they  are  removed,  the  bicus- 
pides soon  appear. 

[The  shedding  of  the  first,  and  often  the  second  tempo- 
rary molares,  takes  place  previous  to  that  of  the  temporary 
cuspidati,  so  that  when  it  becomes  necessary  to  procure 
room  for  the  permanent  cuspidati,  it  has  to  be  obtained 
by  the  removal  of  the  first  or  second  bicuspides,  or  when 
the  first  permanent  molares  are  decayed,  by  the  extrac- 
tion of  these  teeth,  instead  of  the  first  temporary  molares 
12 


86       TREATMENT    TO    PREVENT    IRREGULARITY. 

as  recommended  by  Mr.  Fox.  But  it  is  only  in  the 
fewer  number  of  cases  that  the  resources  of  art  are  re- 
quired in  the  dentition  of  the  secondary  teeth.  Nature 
in  most  instances,  is  amply  sufficient  to  manage  her  own 
work.  Irregularity  of  the  teeth  more  frequently  results 
from  the  premature  removal  of  the  temporary  teeth,  than 
from  their  retention  too  long  in  the  jaws.] 

After  this,  the  treatment  must  be  guided  by  circum- 
stances. If  either  of  the  cuspidati  exhibit  signs  of  early 
approach,  and  there  be  scarcely  room  between  the  latter 
incisor  and  the  bicuspis  already  in  its  place,  it  will  be 
proper  to  take  out  the  second  temporary  molaris,  the  first 
bicuspis  will  then  go  somewhat  back  and  the  cuspidatus 
will  get  more  room. 

When  the  second  temporary  molares  have  been  re- 
moved, there  remain  no  other  obstacles  in  the  way  of  the 
completion  of  the  second  dentition.  The  second  bicus- 
pides  will  come  properly  into  their  places,  and  the  mo- 
lares having  no  obstruction,  will  progressively  occupy 
their  proper  stations. 

Though  the  shedding  of  the  teeth  generally  requires  a 
period  of  four  or  five  years,  it  sometimes  occupies  nearly 
six  years.  In  some  children  the  changes  take  place 
quickly,  and  in  others  slowly.  I  have  seen  a  child  of 
only  seven  years  of  age  more  advanced  in  the  process  of 
dentition,  than  another  of  the  same  family  when  near 
eleven. 


CHAPTER    SEVENTH. 

THE    TREATMENT    TO    REMEDY    IRREGULARITIES    OF    THE    TEETH- 

[There  is  no  truth  in  surgery,  more  fully  established, 
than  is  that  of  the  practicability  of  altering  the  position 
of  a  tooth  in  the  mouth,  after  the  completion  of  its 
growth;  and  yet  there  is  no  branch  of  practice  in  den- 
tistry more  neglected  than  the  treatment  of  irregularity 
in  the  arrangement  of  these  organs.  Notwithstanding 
the  acknowledged  importance  of  regularity  in  the  ar- 
rangement of  the  teeth,  not  only  to  an  agreeable  expres- 
sion of  the  countenance,  but  also  to  the  health  and 
durability  of  the  whole  dental  apparatus — hardly  one 
practitioner  in  twenty  ever  gives  the  subject  a  thought. 
Their  manipulations  are  almost  wholly  confined  to  filing 
and  plugging  the  natural  teeth  and  the  substitution  of  ar- 
tificial ones  for  their  loss.  The  attention  of  a  few  of  the 
more  scientific  and  skilful  practitioners,  however,  have 
been  directed  to  the  treatment  of  irregularity,  and  the 
results  of  their  labour  in  this  department  of  physical  alle- 
viation, have  been  as  gratifying  to  their  own  feelings  as 
they  have  been  beneficial  to  their  patients. 

The  cases  of  irregularity  of  the  teeth  are  so  various 
and  sometimes  complicated  in  their  nature,  that  the  skill, 
patience  and  ingenuity  of  the  operator  are  often  put  to 
the  severest  test.  Different  cases  require  to  be  treated 
differently.      To  construct  the  appliance  best  calculated 


88  VARIETIES    OF    IRREGULARITIES 

to  overcome  the  difficulty  in  every  case,  requires  no  small 
amount  of  tact  and  inventive  ingenuity.  It  often  too, 
becomes  necessary  to  vary  the  means  employed  in  the 
same  case,  or  to  use  different  fixtures  in  different  parts  of 
the  operation;  and  the  length  of  time  required  for  its 
accomplishment,  is  sometimes  such  as  to  call  for  a  greater 
amount  of  patience  and  perseverance  on  the  part  of  both 
practitioner  and  patient,  than  every  one  can  be  prevailed 
upon  to  exercise.  A  deviating  tooth  cannot  always  be 
moved  to  the  place  which  it  should  occupy  in  a  day  or  a 
week.  Months  are  oftentimes  required  to  do  it,  and 
during  the  whole  progress  of  the  operation,  the  most 
constant  attention  is  necessary.] 

The  mode  of  treatment  described  in  the  preceding 
chapter,  is  not  always  had  recourse  to,  at  a  time  when 
every  irregularity  might  be  easily  obviated.  Parents 
most  commonly  wait,  until,  by  an  irregular  growth  of 
their  children's  teeth,  a  manifest  deformity  is  produced, 
ere  they  perceive  the  necessity  of  advice. 

In  all  cases  of  irregularity  during  the  shedding  of  the 
teeth,  the  treatment  to  be  observed  is  to  remove  the  ob- 
structing temporary  teeth,  and  then  to  apply  pressure  in 
the  most  convenient  manner  upon  the  irregular  tooth,  in 
order  to  direct  it  into  its  proper  situation. 

[VARIETIES  OF  IRREGULARITIES  OF  THE  TEETH.] 

I  will  now  describe  the  different  states  of  irregularity, 
and  to  avoid  confusion,  take  each  jaw  separately. 

In  the  under  jaw,  when  the  growth  of  the  permanent 
central  incisores  has  exceeded  the  absorption  of  the  tem- 
porary ones,  they  growT  up  immediately  behind  them,  in 
a  direction  towards  the  tongue.  These  two  new  teeth 
are  generally  so  broad  as  nearly  to  cover  the  inner  sur- 


OF    THE    TEETH.  89 

face  of  the  four  temporary  incisores.  It  will  therefore 
be  necessary,  in  order  to  obtain  room  for  these  teeth,  that 
the  four  temporary  incisores  be  extracted.  The  new 
teeth  will  then  gradually  come  forward,  in  which  they 
will  naturally  be  assisted  by  the  pressure  of  the  tongue 
of  the  child,  and  may  be  occasionally  helped  by  the 
finger  of  the  parent  or  nurse.* 

If  the  temporary  central  incisores  have  loosened,  and 
come  out  previous  to  the  appearance  of  the  permanent 
teeth,  the  space  is  seldom  sufficiently  wide,  and  the  new 
teeth  will  either  grow  up  with  their  sides  turned  forward, 
or  one  will  be  placed  before  the  other.  In  this  case  the 
two  lateral  incisores  must  be  taken  out.f 

When  the  permanent  central  incisores  have  completely 
grown  up,  they  occupy  full  two-thirds  of  the  space, 
which  contained  the  four  temporary  incisores;  therefore, 
when  the  permanent  lateral  incisores  appear,  they  are 
placed  partly  behind  the  centrals  and  the  temporary  cus- 
pidati ;  or  they  grow  up  with  one  corner  turned  forwards 
and  the  other  pointing  backwards.  In  either  of  these 
cases  the  temporary  cuspidati  must  be  removed  to  give 
room. J 

[This  arrangement,  is  often,  though  not  always,  forced 
upon  the  lateral  incisores  by  want  of  room  between  the 
centrals  and  cuspidati.  The  space  between  the  last  men- 
tioned teeth  is  often  amply  sufficient  for  the  four  inci- 
sores.] 

The  four  permanent  incisores  take  up  nearly  the  whole 
of  the  space  of  the  temporary  incisores  and  cuspidati. 
The  permanent  cuspidati  are  large  teeth,  and  when  they 
have  not  sufficient  room,  they  occasion  very  great  irregu- 
larity. Sometimes  they  come  through  on  the  inside,  but 
most  commonly  they  cut  the  gum  on  the  outside,  and 

•Plate  XII.  Fig.  1.  f  Fig.  2.  JFig.3,4. 


90  VARIETIES    OF    IRREGULARITIES 

project  very  much  out  of  the  circular  line  from  the  tem- 
porary incisores  to  the  temporary  molares.  In  this  case 
the  necessity  of  the  removal  of  the  first  temporary  molares 
is  obvious.* 

[The  author  here  has  evidently  mistaken  the  order  of 
the  eruption  of  the  permanent  teeth.  The  first  tempo- 
rary molares  and  oftentimes  the  second  are  replaced  with 
bicuspides  before  the  cuspidati  appear,  so  that  if  the  re- 
moval of  any  teeth  becomes  necessary  to  make  room  for 
the  last  mentioned  organs,  it  will  be  the  first  or  second 
bicuspides,  but  as  these  are  much  smaller  than  their  pre- 
decessors, it  is  comparatively  seldom  that  the  sacrifice  of 
any  is  called  for.] 

It  is  not  very  common  that  the  bicuspides  of  the  lower 
jaw  are  irregular,  because  the  temporary  molares  are  gen- 
erally removed  before  they  appear;  but  when  this  is  not 
the  case,  they  always  come  through  the  gums  on  the  in- 
side, pointing  towards  the  tongue,  in  which  case  the  tem- 
porary molares  must  be  removed,  that  the  bicuspides  may 
rise  into  their  proper  situations.! 

In  the  upper  jaw  the  permanent  central  incisores  some- 
times pass  through  the  gums  behind  the  temporary  ones; 
when  this  happens,  the  four  temporary  incisores  must  be 
extracted,  [if  the  wrong  direction  taken  by  the  former 
has  resulted  from  want  of  room  between  the  latter,]  and 
frequent  pressure  by  the  thumb  should  be  applied  to  the 
new  teeth,  in  order  to  bring  them  forward  as  soon  as 
possible,  and  prevent  one  of  the  cases  of  irregularity  most 
difficult  to  be  remedied. 

When  the  temporary  central  incisores  have  come  out, 
the  space  is  generally  too  narrow  for  the  permanent  ones, 
and  hence  they  are  pressed  into  some  shape  of  distortion. 
Their  edges  do  not  assume  the  regular  curve,  but  stand 

*  Plate  XII.  Fig.  5.  f  Fig.  6. 


OF    THE    TEETH.  91 

obliquely,  or  even  sometimes  one  before  the  other.  Ca- 
ses of  this  kind  require  the  removal  of  the  temporary 
lateral  incisores.* 

[The  practice  recommended  in  the  last  paragraph,  is 
based  upon  the  erroneous  belief  that  the  anterior  part  of 
the  jaw  acquires  no  increase  of  dimensions  after  the  den- 
tition of  the  temporary  teeth.  But  by  the  slight  increase 
which  takes  place  in  this  part  of  the  alveolar  border  and 
the  yielding  of  the  temporary  lateral  incisores,  to  the 
pressure  of  the  permanent  centrals,  the  latter,  in  the  ma- 
jority of  cases,  acquire  their  proper  position  between  the 
former.  Therefore,  it  is  only  when  they  are  forced  to 
take  a  wrong  direction  in  their  growth,  by  want  of  room 
between  the  temporary  lateral  incisores,  that  these  last 
should  be  extracted.] 

The  permanent  central  incisores  are  very  broad;  they 
occupy  the  greater  part  of  the  space  of  the  four  temporary 
ones,  and  leave  scarcely  any  room  for  the  permanent  late- 
ral incisores;  on  which  account  these  latter  teeth  must 
grow  very  irregularly;  they  generally  pass  through  be- 
hind, being  forced  considerably  backwards  by  the  resist- 
ance of  the  central  incisores  and  the  temporary  cuspidati. 
Some  times  they  pass  through  edgeways,  and  now  and 
then  they  project  forwards.  In  any  of  these  cases  the  re- 
moval of  the  temporary  cuspidati  is  absolutely  necessary, 
and  unless  the  operation  be  timely  performed,  the  irregu- 
larity is  with  difficulty  remedied. f 

[As  has  been  intimated  in  a  preceding  place,  a  tempo- 
rary tooth  should  not  be  extracted,  except  to  make  room 
for  a  permanent  one,  or  when  called  for  by  some  other 
special  necessity.  The  practice  in  the  preceding  para- 
graph, as  that  in  the  one  noticed  before  it,  is  based  upon 
a  false  theory.] 

*  Plate  XII.  Fig.  7.  |  Fig.  3,  9. 


92  VARIETIES    OF    IRREGULARITIES 

The  greatest  deformity  is  generally  occasioned  by  the 
want  of  room  for  the  lateral  incisores  and  the  cuspidati, 
and  when  too  long  neglected  usually  becomes  permanent. 

When  the  permanent  cuspidati  make  their  appearance, 
[in  an  improper  place]  they  generally  project  very  much 
forwards,  and  not  only  disfigure  the  mouth,  but  are  very 
dangerous.  I  have  known  several  instances,  where,  from 
the  accident  of  a  blow,  the  upper  lip  has  been  cut  through. 
Whenever  the  cuspidati  are  growing  thus,  the  first  tem- 
porary molares  ought  to  be  extracted.* 

When  the  bicuspides  appear  before  the  temporary 
molares  have  been  [removed  by  the  destruction  of  their 
roots  or]  extracted,  they  pierce  the  gums  above  the  shed- 
ding teeth,  and  may  be  seen  by  raising  the  cheek  and 
upper  lip.  The  removal  of  the  temporary  molares  im- 
mediately permits  them  to  come  down  into  their  right 
situation.!  [Irregularity  in  the  arrangement  of  these 
teeth  is,  however,  of  comparatively  rare  occurrence.] 

In  almost  all  the  cases  of  irregularity  which  occur  in 
the  under  jaw,  nothing  more  is  necessary  after  the  re- 
moval of  the  obstructing  tooth,  than  to  apply  the  frequent 
pressure  of  the  finger,  in  such  a  manner  as  to  direct  the 
irregular  tooth  into  its  proper  place.  It  will  assist  the 
natural  tendency  of  the  teeth  to  form  a  regular  circle,  and 
to  take  up  as  large  a  space  as  possible.  But  in  the  upper 
jaw,  when  the  irregularity  has  been  suffered  to  remain 
for  any  length  of  time,  it  cannot  be  obviated  without 
having  recourse  to  other  assistance. 

Irregularity  is  often  occasioned  by  the  teeth  being 
much  too  large  for  the  space  allotted  them,  and  then  it 
will  be  necessary  to  remove  one  or  more  of  the  perma- 
nent teeth. 

When    the    incisores   are   perfectly    regular,  and    the 

•Plate  XII.  Fig.  10.  t  Fig.  ll. 


OF    THE    TEETH.  93 

bicuspides  have  appeared  before  the  cuspidati,  there  is 
so  little  space  left,  that  the  cuspidati  are  thrust  forward.* 

It  has  been  the  common  practice  to  admit  the  cuspidati 
to  grow  down  to  a  certain  length,  and  then  to  extract 
them.  This  operation  certainly  removes  the  deformity 
of  projecting  teeth,  but  it  destroys  the  symmetry  of  the 
mouth,  and  takes  away  two  teeth  of  great  importance. 
The  cuspidati  are  exceedingly  strong;  they  form  the 
support  of  the  front  of  the  mouth,  and  in  the  advanced 
periods  of  life,  to  those  persons  who  have  the  misfortune 
to  lose  the  incisores,  they  furnish  an  excellent  means  of 
fixing  artificial  teeth.  [The  practice,  formerly  so  com- 
mon, of  attaching  artificial  teeth  to  the  cuspidati,  is,  at  the 
present  time,  seldom  adopted,  when  there  are  other  teeth 
in  the  mouth  further  back,  to  which  a  support  for  artificial 
ones  can  be  attached.] 

On  these  accounts  [or  more  properly  for  the  reason  first 
stated,]  they  should  be  preserved,  and  therefore  it  will  be 
right  to  extract  the  first  bicuspis  on  each  side.  The 
cuspidati  will  then  fall  into  the  circle,  and  if  there  should 
be  any  vacant  space,  it  will  be  so  far  back,  that  no  defect 
will  be  perceived.  This  is  often  the  case  in  the  under 
jaw,  as  well  as  in  the  upper,  and  the  same  practice  ought 
to  be  adopted. 

[The  better  practice,  in  cases  of  this  sort,  is,  to  extract 
the  second,  instead  of  the  first  bicuspis,  as  recommended 
above,  except  when  the  space  between  the  first  and  the 
lateral  incisor,  is  very  narrow,  say  not  more  than  equal  to 
one-third  the  wTidth  of  the  cuspidatus,  and  in  which  case 
the  first  should  be  removed  instead  of  the  second,  for 
although  after  the  extraction  of  the  other,  it  might  be 
made  to  take  its  place,  and  the  deviating  tooth  brought 
within  the  circle,  yet  still  there  would  be  such  an  over- 

*  Plate  XII.  Fig.  12. 


94  VARIETIES    OF    IRREGULARITIES 

taping  of  the  roots  of  the  two  within  their  sockets,  as 
would  occasion  a  considerable  prominence  on  the  anterior 
part  of  the  alveolar  border,  which  would  be  likely  to  give 
rise  to  an  unhealthy  action  in  the  investing  soft  tissues.] 

The  first  permanent  molares  often  become  carious  soon 
after  they  appear;  when  this  is  the  case,  and  the  other 
teeth  have  not  sufficient  room,  considerable  advantage 
always  attends  their  extraction.  Their  removal  permits 
the  bicuspides  to  fall  back,  and  gives  way  for  the  regular 
position  of  the  cuspidati. 

The  removal  of  these  teeth  when  decayed  ought  always 
to  be  recommended,  although  they  may  not  occasion  pain, 
or  there  be  no  irregularity  in  the  front  teeth;  diseased 
teeth  always  affect  others,  and  therefore  ought  never  to 
remain  in  the  mouths  of  children. 

If  they  be  extracted  before  the  second  permanent 
molares  appear,  in  a  short  time  they  will  not  be  missed, 
because  the  bicuspides  will  go  back,  and  the  second  and 
third  molares  will  come  forward,  so  that  no  space  will  be 
left. 

[When  there  is  irregularity  in  the  front  teeth,  or  good 
reason  for  believing  there  will  be,  or  that  they  will  be 
crowded  unless  some  of  the  permanent  teeth  are  removed, 
the  extraction  of  the  first  permanent  molares  when  de- 
cayed, is  unquestionably  advisable,  but  under  any  other 
circumstances,  the  decision  of  the  practitioner,  should  be 
determined  by  the  situation  and  extent  of  the  disease. 
If  the  decay  has  commenced  on  the  grinding  surface  of 
the  tooth,  and  has  not  invaded  a  very  considerable  portion 
of  the  organ,  the  better  practice  would  be  to  remove  the 
diseased  part,  and  fill  the  cavity  with  gold.] 

The  front  teeth  may  even  derive  much  benefit  from 
this  gain  of  room,  as  there  will  probably  be  left  a  small 
space  between  them,  which  will  tend  to  their  preserva- 


OF    THE    TEETH.  95 

tion;  for  it  is  observed,  when  teeth  are  situated  so  close 
as  to  press  hard  upon  each  other,  they  almost  always  fall 
into  a  state  of  decay. 

Sometimes  the  upper  jaw  is  too  narrow  from  side  to 
side,  the  teeth  in  the  fore  part  are  thrown  forwards,  and 
project  very  much  over  the  teeth  of  the  lower  jaw :  they 
also  push  out  the  upper  lip.  In  this  case  the  first  bicuspis 
on  each  side  should  be  extracted,  which  will  permit  the 
teeth  to  fall  into  a  more  regular  curve.  [But  should  they 
fail  to  do  so,  they  should  be  brought  back  by  means  of 
ligatures  attached  to  one  or  more  of  the  molares,  and  so 
applied  to  them,  that  a  constant  and  regular  pressure  shall 
be  kept  upon  them  in  the  direction  they  require  to  be 
moved,  only  one  tooth,  however,  on  each  side  should  be 
moved  at  a  time.] 

When  the  permanent  incisores  of  the  upper  jaw  have 
cut  the  gum  behind  the  temporary  teeth,  and  have  been 
suffered  to  remain  until  considerably  advanced  in  growth, 
they  always  stand  so  much  inwards,  that  when  the  mouth 
is  shut,  the  incisores  of  the  under  jaw  stand  before  them, 
which  is  always  an  obstacle  to  their  acquiring  regularity, 
and  occasions  a  great  deformity. 

There  are  four  states  of  this  kind  of  irregularity.  The 
first,  when  one  central  incisor  is  turned  in,  and  the 
under  teeth  come  before  it,  whilst  the  other  central  incisor 
keeps  its  proper  place,  standing  before  the  under  teeth.* 

The  second  is,  when  both  the  central  incisores  are 
turned  inj  and  go  behind  the  under  teeth;  but  the  lateral 
incisores  stand  out  before  the  under  teeth. f 

The  third  variety  is,  when  the  central  incisores  are 
placed  properly,  but  the  lateral  incisores  stand  very  much 
in;  and  when  the  mouth  is  shut,  the  under  teeth  project 
before  them  and  keep  them  backward. J 

*  Plate  XTII.  Fig.  1.  tFig.  2.  J  Fig.  3. 


96  VARIETIES    OF    IRREGULARITIES 

The  fourth  is,  when  all  the  incisores  of  the  upper  jaw 
are  turned  in,  and  those  of  the  under  jaw  shut  before 
them.  This  is  sometimes  occasioned  by  too  great  a 
length  of  the  under  jaw,  in  consequence  of  which  it 
projects  considerably  more  forward  than  the  upper  jaw.* 
But  the  majority  of  such  cases  originate  entirely  from 
neglect,  and  may  be  completely  remedied  by  early  as- 
sistance. 

[It  is  also  proper  to  state  that  the  cuspidati  as  well  as 
the  incisores  sometimes  come  out  behind  the  dental  arch, 
so  as  at  each  occlusion  of  the  jaws,  to  strike  behind  the 
lower  teeth.  But  this  variety  of  irregularity  with  these 
teeth  is  less  frequent  than  with  the  incisores.  The 
editor  has,  however,  treated  several  cases  within  the 
last  four  years,  and  he  has  one  case  at  this  time  under 
treatment.  Plate  XIV.  Fig.  8,  represents  an  inclined 
plane  which  he  employed  for  the  purpose  of  bringing 
a  deviating  cuspidatus  forward  to  its  proper  place  in  the 
dental  circle.] 

The  time  to  affect  any  material  alteration  in  the  posi- 
tion of  the  teeth,  is  before  thirteen  or  fourteen  years  of 
age,  and  as  much  earlier  as  possible;  for  after  that  time 
the  sockets  of  the  teeth  acquire  a  great  degree  of 
strength,  and  the  teeth  are  so  fixed  that  they  cannot  be 
moved  without  much  difficulty.  If  the  irregularity  be  left 
to  a  much  later  period,  it  becomes  a  great  deal  more  dif- 
ficult to  produce  any  alteration,  and  frequently  all  attempts 
are  fruitless. 

[Not  only  is  the  difficulty  increased  by  delaying  to  a 
later  period,  and  especially  after  the  twentieth  or  twenty- 
first  year,  but  an  increased  susceptibility  to  morbid  im- 
pressions will  be  induced  in  the  sockets  of  the  teeth, 
whose  position  has  been  changed,  which  will  ever  after 

•Plate  XIII.  Fig.  4. 


OF    THE    TEETH.  97 

remain,  and  render  them  more  liable  to  the  attacks  of 
disease.] 

To  remove  the  kind  of  irregularity  above  mentioned, 
two  objects  must  be  accomplished ;  one,  to  apply  a  force 
which  shall  act  constantly  upon  the  irregular  tooth,  and 
bring  it  forward;  the  other,  to  remove  that  obstruction 
which  the  under  teeth,  by  coming  before  the  upper, 
always  occasion. 

The  first  of  these  objects  may  be  attained  by  the  appli- 
cation of  an  instrument  adapted  to  the  arch  of  the  mouth, 
which,  being  attached  to  some  strong  teeth  on  each  side, 
will  furnish  a  fixed  point  in  front,  to  which  a  ligature 
previously  fastened  on  the  irregular  tooth  may  be  applied, 
and  thus,  by  occasionally  renewing  it,  a  constant  pressure 
is  preserved,  and  the  tooth  may  be  drawn  forward. 

The  second  object,  that  of  removing  the  resistance  of 
the  under  teeth,  must  be  attained  by  placing  some  inter- 
vening substance  between  the  teeth  of  the  upper  and 
under  jaws,  so  as  to  prevent  them  from  completely 
closing,  and  be  an  obstruction  to  the  coming  forwards 
of  the  irregular  tooth. 

The  instrument  may  be  made  of  gold  or  silver;  it 
should  be  so  strong  as  not  easily  to  bend;  if  about  the 
sixteenth  of  an  inch  in  breadth,  and  of  a  proportionate 
thickness,  it  will  be  sufficiently  firm.  This  bar  of  gold 
must  be  bent  to  the  form  of  the  mouth,  and  should  be 
long  enough  to  reach  to  the  temporary  [or  first  perma- 
nent] molares,  which  are  the  teeth  to  which  it  is  to  be 
tied.  Holes  are  to  be  drilled  in  it  at  those  places  where 
ligatures  are  required,  which  will  be  on  the  parts  op- 
posed to  the  teeth  designed  to  be  the  fixed  points,  and 
also  at  the  parts  opposite  to  the  place  where  the  irreg- 
ular tooth  or  teeth  are  situated.  Then  to  the  bar  a 
small  square  piece  of  ivory  is  to  be  connected,  by  means 


98  VARIETIES    OF    1  RR  E  G  UL  A  RI  T  IE  S 

of  a  little  piece  of  gold,  which  may  be  fastened  to  the 
ivory  and  the  bar  by  two  rivets.  This  piece  of  ivory 
passes  under  the  grinding  surfaces  of  the  upper  teeth,  is 
kept  there  fixed,  and  prevents  the  teeth  from  closing, 
and  consequently  takes  off  all  obstruction  in  front.* 

[Gold  caps  are  now  pretty  generally  employed  instead 
of  blocks  of  ivory.  These,  when  well  adapted  to  the 
teeth  over  which  they  are  placed,  are  far  preferable,  as 
they  are  less  annoying  to  the  patient,  and  can  conse- 
quently be  worn  with  less  inconvenience.  The  first  per- 
manent molares  are  the  most  suitable  teeth  to  be  em- 
ployed for  the  purpose.  The  second  temporary  molares, 
may,  however,  be  used,  or  if  they  have  been  molted  and 
replaced  with  bicuspides,  these  will  answer,  though  less 
suitable  than  either  of  the  others.  When  caps  are  used, 
it  is  not  necessary  to  attach  them  to  the  gold  bar  passing 
round  the  front  teeth.] 

The  bar  is  to  be  attached  by  a  strong  silk  ligature  to 
the  teeth  at  the  sides,  so  that  if  possible,  it  may  remain 
tight  as  long  as  it  is  required;  a  ligature  is  then  to  be 
tied  around  the  irregular  tooth,  and  the  ends,  being 
brought  through  the  holes  in  the  bar,  are  to  be  tied  in  a 
firm  knot.  In  two  or  three  days  this  ligature  must  be 
removed  and  a  new  one  applied;  the  tooth  will  soon  be 
perceived  to  move.  A  fresh  ligature  must  be  used  every 
three  or  four  days,  in  order  to  keep  up  a  constant  pres- 
sure, sufficiently  powerful  to  bring  the  tooth  into  a  line 
with  the  others. f 

The  same  mode  of  treatment  is  to  be  observed  whether 
there  be  one,  two,  or  three  teeth  growing  in  a  similar 
manner.  The  teeth  are  usually  brought  forwards  in 
about  a  month  or  five  weeks,  and  as  soon  as  they  are  so 

*  Plate  XIII.  Fig.  5.  f  Fig.  G,  7. 


OF    THE    TEETH.  99 

much  advanced  as  to  allow  the  under  teeth  to  pass  on  the 
inside,  the  piece  of  ivory  may  be  removed,  and  the  bar 
only  be  retained  for  a  few  days,  until  the  teeth  are  per- 
fectly firm,  which  will  prevent  the  accident  of  the  teeth 
again  receding. 

[The  gold  bar  and  caps  should  be  removed,  and  the 
teeth  thoroughly  cleansed,  every  time  the  ligatures  are 
removed.  This  is  necessary  to  prevent  the  teeth  from 
being  injured  by  the  chemical  action  of  the  corrosive 
matter  that  forms  between  them  and  the  gold  bar,  caps 
and  ligatures.] 

In  cases  where  the  irregularity  has  been  suffered  to 
continue  too  long,  no  success  can  be  expected  to  follow 
attempts  to  remove  it;  we  must  content  ourselves  in  the 
treatment  of  these  cases  in  adults,  with  taking  away  the 
most  irregular  teeth,  and  thus,  as  much  as  possible,  lessen 
the  deformity. 

[Various  other  methods  have  been  proposed  and 
adopted  for  the  purpose  of  remedying  irregularity  of  the 
teeth.  M.  Delabarre  recommends  the  employment  of 
ligatures,  so  applied,  as  to  keep  up  a  constant  action 
upon  the  deviating  teeth.  Instead  of  using  blocks  of 
ivory  or  gold  to  prevent  the  teeth  from  coming  together 
and  forming  a  permanent  obstacle  to  the  adjustment  of 
a  tooth  which  has  come  out  so  far  back  of  the  dental 
circle,  as  to  fall  behind  the  lower  teeth  every  time  the 
mouth  is  closed,  he  employs  wire  caps  or  grates  placed 
upon  two  of  the  lower  molares.  (See  Plate  XIV.  Fig. 
5.)  This  treatment,  if  it  were  the  most  efficient,  would 
for  several  reasons  be  objectionable.  In  the  first  place, 
the  ligatures,  when  applied  so  as  to  act  upon  a  deviating 
tooth,  acts  with  equal  force  upon  the  adjoining  teeth,  and 
moves  them  just  as  far  from  their  place,  as  it  does  the 
other  toward  the  place  it  should  occupy.     In  the  second 


100  VARIETIES    OF    IRREGULARITIES 

place,  it  is  difficult  to  apply  it  so  as  to  prevent  it  from 
coming  in  contact  with  and  irritating  the  gums.  Thirdly, 
it  cannot  be  made  to  act  with  as  much  force  when  thus 
applied  as  when  used  in  connection  with  the  gold  bar. 
The  fourth  and  last  objection,  applies  to  the  wTire  grates. 
These  cannot  be  fixed  to  the  teeth  as  readily  as  either 
the  ivory  blocks  or  gold  caps,  and  such  as  could  be 
conveniently  employed  for  the  purpose,  would  not  inter- 
pose a  barrier  sufficiently  thick  in  all  cases  to  prevent  the 
front  teeth  from  coming  together. 

For  remedying  the  description  of  irregularity  under 
consideration,  M.  Catalan  proposes  the  employment  of 
an  inclined  plane,  which  may  be  made  either  of  gold  or 
silver,  but  the  former  is  preferable,  as  the  latter  is  liable 
to  corrode  in  the  mouth,  fixed  upon  the  lower  teeth,  in 
such  a  way  that  it  shall  strike  behind  the  deviating  tooth, 
at  each  occlusion  of  the  jaws,  and  press  it  forward 
toward  the  place  it  should  occupy.  When  several  of  the 
upper  front  teeth  had  come  out  behind  the  arch  so  as  to 
fall  behind  the  lower  incisores,  Catalan  employed  as 
many  inclined  planes  as  there  were  deviating  teeth.  See 
Plate  XIV.  Figs.  1,  2,  for  a  copy  of  the  engraving  of  his 
instrument,  taken  from  the  Journal  General  de  Medec)ne, 
de  Chirurgie  et  de  Pharmacie,  for  January,  1814,  and 
the  representation  here  given  will  supercede  the  neces- 
sity of  any  other  description.  When  only  one  tooth 
strikes  behind  the  circle  of  the  lower  teeth,  a  single  in- 
clined plane  will  be  all  that  is  necessary,  as  in  the  case 
represented  in  Plate  XIV.  Figs.  6,  7,  8. 

The  gold  frame  or  case  applied  to  the  lower  teeth,  and 
to  which  the  inclined  plane  is  attached,  should  be  fitted 
with  the  nicest  accuracy,  and  made  to  enclose  one  or 
both  of  the  bicuspides  on  each  side.  The  cutting  edges 
of  the  incisores  and  points  of  the  cuspidati  need  not  be 


OF    THE    TEETH.  101 

covered  with  it.  Its  adaptation,  when  applied,  should  be 
such  as  to  hold  it  firmly  and  securely  in  its  place,  and 
prevent  the  action  of  the  deviating  tooth  upon  the  in- 
clined plane  from  jostling  or  moving  it  in  the  least.  It 
will  be  necessary  too  in  adjusting  the  inclined  planes  to 
this  frame,  so  that  they  shall  act  upon  the  right  points  on 
the  deviating  teeth,  to  have  a  plaster  antagonizing  model. 
The  manner  of  obtaining  this  will  be  described  in  another 
part  of  this  work. 

When  this  instrument  is  employed,  it  of  course  is  not 
necessary  to  interpose  any  substance  between  the  back 
teeth,  and  it  is  unquestionably  the  most  efficient  and  pow- 
erful agent  that  has  ever  been  used  for  remedying  this 
description  of  irregularity.  But  before  it  is  applied,  it 
should  be  ascertained  whether  there  be  a  sufficient  aper- 
ture in  the  dental  circle  for  the  reception  of  the  deviating 
tooth,  or  teeth,  if  there  be  more  than  one,  and  if  there  is 
not,  more  room  should  be  obtained  by  the  removal  of  one 
of  the  bicuspides  on  each  side,  or  the  first  molaris,  if  that 
be  decayed.  The  tooth  too,  which  is  to  be  brought  for- 
ward, should  always  be  opposite  the  aperture  it  is  in- 
tended it  should  occupy,  before  it  is  submitted  to  the 
action  of  the  inclined  plane.  Therefore,  when  it  is  situ- 
ated at  either  side,  as  is  often  the  case,  it  should  be 
moved  with  ligatures,  to  a  point  directly  behind  the  va- 
cuity, in  which  it  is  intended  it  should  be  forced,  by  the 
inclined  plane,  before  that  is  applied. 

It  often  happens,  that  one  or  more  of  the  teeth,  though 
situated  in  the  circle,  stands  obliquely  or  transversely 
across  it,  so  that  its  anterior  and  posterior  surfaces,  pre- 
sent laterally.  All  that  is  necessary  in  cases  of  this  sort, 
is  simply  to  turn  the  tooth  or  teeth,  if  there  be  more  than 
one,  partially  round,  in  their  sockets.  To  do  this,  M. 
Delabarre  applies  a  gold  cap  to  the  twisted  tooth,  with 
14 


\ 


102  IRREGULARITIES    OF    THE    TEETH. 

ligatures  attached  to  each  side,  which  he  passes  round 
the  adjoining  teeth  and  secures  to  the  temporary  molares 
or  bicuspides  on  either  side,  in  such  a  manner  as  to  make 
them  act  constantly  in  the  direction  the  tooth  is  to  be 
turned,  upon  it.*  I  have  found  a  gold  ring,  properly 
fitted  to  the  tooth,  to  answer  better  than  a  cap,  for  the 
reason  that  it  is  less  annoying  to  the  patient.  The  object 
may  sometimes  be  accomplished  with  ligatures  alone.] 

♦Plate  XIV.  Fig.  3,4. 


CHAPTER    EIGHTH. 


OF    SUPERNUMERARY    TEETH. 


The  growth  of  more  teeth  than  the  natural  number 
frequently  occurs,  and  is  always  the  cause  of  great  irregu- 
larity of  the  teeth.  It  most  commonly  happens  that 
supernumerary  teeth  are  met  with  in  the  upper  jaw,  and 
they  are  chiefly  placed  in  some  part  about  the  incisores 
and  cuspidati.  They  are  only  rarely  met  at  the  posterior 
part  of  the  mouth,  and  then  they  resemble  small  dentes 
sapiential  being  placed  on  one  side  or  other  of  those 
teeth. 

The  form  of  supernumerary  is  very  different  from  that 
of  any  of  the  other  classes  of  teeth;  they  are  generally 
small  round  teeth,  resembling  the  point  of  a  quill,*  and 
sometimes  they  are  not  much  unlike  a  broad  bicuspis  of 
the  under  jaw.y 

When  these  teeth  appear,  they  always  create  a  con- 
siderable deformity;  commonly  there  is  only  one  of  them, 
and  that  is  placed  either  between  the  central  incisores,  or 
projecting  over  them,  or  between  the  central  and  the 
lateral  incisores,  or  behind,  turning  towards  the  roof  of 
the  mouth. J 

When  there  are  two  supernumerary  teeth,  the  fore 
part  of  the  mouth  is  so  filled  as  to  occasion  the  incisores 
and  cuspidati  to  be  placed  in  a  double  row.     I  have  seen 

♦Plate  XIII.  Fig.  1.  t  Fig.  2.  {Kg.  4,5. 


104  OF    SUPERNUMERARY    TEETH. 

three  remarkable  instances  of  this  kind:  in  one,  there 
were  two  supernumerary  teeth,  of  the  conical  kind,  which 
were  placed  together,  and  had  come  behind  and  between 
the  central  incisores,  which  they  had  thrust  forwards. 
The  lateral  incisores  grew  in  a  line  even  with  the  super- 
numerary teeth,  behind  the  central  incisores  and  cuspidati, 
and  so  formed  a  second  row.  This  was  the  most  con- 
spicuous deformity  of  the  teeth  I  ever  saw,  for  the  mouth 
could  not  be  opened  to  speak,  without  completely  pre- 
senting them  to  view.* 

In  the  other  two  cases  the  supernumerary  teeth  re- 
sembled bicuspides  of  the  lower  jaw;  they  had  large 
crowns,  with  depressions  at  their  bases,  and,  by  thrusting 
the  other  teeth  into  very  improper  situations,  produced 
an  appearance  of  a  double  row.f 

[Supernumerary  teeth  are  sometimes  met  with  which 
bear  so  close  a  resemblance  to  the  others,  that  it  is  impossi- 
ble to  distinguish  the  one  from  the  other.  I  have  met  with 
several  examples  of  this  sort,  both  in  the  upper  and  lower 
jaws.] 

These  supernumerary  teeth  should  always  be  extracted 
as  soon  as  they  are  perceived;  and  if  they  have  occasioned 
the  other  teeth  to  turn  out  of  their  right  direction,  the 
application  of  a  ligature  will  soon  bring  them  again  into 
their  regular  situation. 

*  Plate  XV.  Fig.  6.  t  Fig.  7. 


CHAPTER  NINTH. 

OF  THE  DECAY  OF  THE  TEMPORARY  TEETH. 

The  temporary  teeth  are  very  liable  to  become  carious, 
and  generally  cause  a  great  deal  of  pain.  Sometimes 
this  disposition  to  decay  shews  itself  very  early;  and  in 
two  or  three  cases  I  have  seen  every  tooth  in  a  diseased 
state  at  so  early  a  period  as  three  years.  The  little  pa- 
tients are  generally  dreadfully  afflicted,  and  by  their  rest 
being  disturbed,  and  their  being  unable  to  masticate  food 
with  comfort,  the  health  is  often  much  impaired.  These 
circumstances  render  the  extraction  of  these  decayed 
teeth  highly  necessary. 

Sometimes  abscesses  of  considerable  extent  form  about 
the  sockets  and  gums  of  these  carious  teeth,  and  produce 
considerable  mischief.  I  have  seen  the  gums  acquire  a 
sloughy  appearance,  discharging  a  quantity  of  fetid  mat- 
ter; and  sometimes  so  much  injury  is  done  as  to  occasion 
the  death  and  exfoliation  of  portions  of  the  jaw  bones; 
when  this  happens  it  usually  extends  so  far  as  to  include 
the  sockets  containing  the  forming  permanent  teeth, 
which  I  have  seen  come  away  with  the  diseased  tempo- 
rary ones.* 

On  these  accounts  it  should  always  be  recommended, 
when  a  child's  teeth  have  become  carious,  and  occasion 
pain,  gum-boils,  or  abscesses,  to  extract  them,  as  they  not 

*  Plate  XVI.  Fig.  12. 


J06   OF  THE  DECAY  OF  THE  TEMPORARY  TEETH. 

only  very  materially  injure  the  health,  but  also  are  liable 
to  prevent  the  formation  of  the  permanent  teeth. 

[The  preservation  of  the  temporary,  as  has  been  stated 
in  a  preceding  place,  until  they  are  removed  by  the  ope- 
rations of  the  economy,  to  give  place  to  the  secondary  or 
permanent  ones,  or  until  the  latter  are  about  to  appear, 
is  of  the  utmost  importance,  and  this,  in  the  majority  of 
cases,  might  be  effected  by  timely  and  proper  attention. 
The  temporary  teeth  should  be  cleansed  with  a  brush 
and  waxed  floss  silk,  three  or  four  times  every  day,  and 
if  this  were  done  from  the  time  they  make  their  appear- 
ance, there  would  not  be  one  decayed  deciduous  tooth 
where  there  are  now  twenty.  But  when  from  neglect  or 
any  other  cause,  they  do  decay,  such  treatment  should 
be  instituted,  as  may  be  best  calculated  to  arrest  the  pro- 
gress of  the  disease.  This,  however,  should  be  had  re- 
course to,  before  the  teeth  have  become  much  loosened 
from  the  wasting  of  their  roots,  for  then,  the  use  of  the 
file  upon  them,  and  plugging,  which  are  the  proper  reme- 
dies for  caries,  might,  by  shaking  them  in  their  sockets, 
cause  injury  to  the  new  teeth  beneath.  But  previously 
to  this  time,  the  treatment  may  be  applied  with  impunity 
and  it  will  be  found  as  successful  in  the  preservation  of 
these  as  the  permanent  teeth.  For  arresting  the  pro- 
gress of  caries  on  the  approximal  surfaces  of  the  tempo- 
rary teeth,  and  especially  the  incisores,  filing  is  preferable 
to  plugging,  but  when  the  decay  is  in  the  grinding  sur- 
face of  the  molares,  the  last  operation  is  the  proper 
remedy. 

Sound  teeth  are  as  desirable  and  just  as  necessary  to 
the  comfort  and  health  of  a  child  as  they  are  to  an  adult, 
and  therefore  they  should  not  be  permitted,  from  neglect 
of  the  means  of  their  preservation,  to  decay,  and  the 
temporary  teeth  require  as  much  care  as  do  the  perma- 


OF  THE  DECAY  OF  THE  TEMPORARY  TEETH.   107 

nent  ones,  and  they  should  never  be  extracted  except  for 
the  relief  of  pain,  that  cannot  be  removed  by  any  other 
means,  or  the  cure  of  an  alveolar  abscess,  or,  as  has  been 
before  stated,  to  make  room  for  a  permanent  tooth.  The 
popular  opinion,  that  inasmuch  as  these  teeth  are  to  be 
replaced  with  others,  it  is  of  little  importance  whether 
they  remain  in  the  mouth  until  they  are  removed  by  na- 
ture to  make  room  for  their  successors,  or  are  lost  a  year 
or  two  earlier,  is  erroneous,  and  has  been  productive  of 
much  injury.] 


CHAPTER    TENTH. 

OF   THE    DISEASES    WHICH    ATTEND    DENTITION. 

The  period  of  dentition  in  children  is  generally  con- 
sidered as  one  of  the  most  critical  in  life.  In  infancy  the 
animal  frame  is  so  delicate,  that  the  least  local  irritation 
produces  a  sudden  and  universal  sympathy  throughout 
the  whole  body.  Hence  the  excitement  occasioned  by 
the  passage  of  the  teeth  through  the  gums  often  gives 
rise  to  the  most  alarming  constitutional  symptoms,  which 
are  always  with  difficulty  alleviated,  and  not  unfrequently 
terminate  in  death. 

The  mode  in  which  the  teeth  pass  through  the  gums  is 
very  much  misunderstood ;  the  prevailing  opinion  is,  that 
as  the  teeth  advance  in  growth,  they  find  their  way 
through  the  gums  by  their  own  mechanical  pressure. 
The  idea  has  given  rise  to  the  common  expression  of 
cutting  the  teeth,  and  the  pain  during  dentition  has  been 
considered  as  being  produced  by  a  laceration  of  the 
membrane  and  gum  covering  the  tooth. 

That  this  is  an  erroneous  opinion  will  be  perceived, 
when  the  state  of  the  teeth  and  gums  at  that  time  is  con- 
sidered. During  its  formation  a  tooth  is  loosely  con- 
tained in  the  socket,  and  can  exert  no  force  sufficient  to 
perforate  so  firm  a  substance  as  the  gums.  The  gums 
also  possess  a  certain  degree  of  elasticity,  and  could  by 
the  gradual  pressure  of  the  rising  teeth,  be  stretched  so 


DISEASES    WHICH    ATTEND    DENTITION.         109 

as  to  become  elongated  with  the  progress  of  the  teeth, 
and  would  continue  to  cover  them. 

A  passage  for  the  teeth  is  opened  by  the  process  of 
ulceration.  By  the  pressure  of  any  extraneous  substance 
upon  a  sound  part,  or  by  a  diseased  enlargement  of  some 
part  within  the  body,  an  absorption  of  the  parts  subjected 
to  the  pressure  will  take  place.  This,  in  a  very  remark- 
able degree,  is  seen  in  cases  of  aneurism,  in  which,  by 
the  pressure  of  a  soft  tumour,  bones  of  the  most  compact 
structure  are  removed  by  the  process*  of  absorption,  and 
that  unattended  with  any  secretion  of  pus. 

[The  foregoing  explanation  of  the  mechanism  of  den- 
tition is  too  general  to  be  very  clearly  or  wrell  understood. 
The  most  ingenious,  and  at  the  same  time  most  plausible 
theory  that  has  been  advanced  upon  this  subject,  is  given 
by  M.  Delabarre.  This  writer  is  of  the  opinion  that  the 
escape  of  a  tooth  from  its  matrix  or  sac,  and  passage 
through  the  gum  is  analogous,  if  not  identical  with  that 
of  the  birth  of  a  child.  He  regards  the  sac  in  connec- 
tion with  its  neck  or  chord  which  passes  from  it  to  the 
surface  of  the  gum,  as  the  prime  agent  in  this  operation 
of  the  economy.  It  is  by  the  retraction  of  this  upon  the 
neck  of  the  tooth  to  which  it  is  attached,  that  the  tooth 
is  raised  from  its  socket  towards  the  mouth  or  orifice  of 
the  matrix,  and  ultimately  brought  to  a  level  with  the 
gums.  The  peduncle  or  chord  leading  from  the  sac  to 
the  surface  of  the  gum,  is  said  by  Goodsir  to  be  solid, 
but  Delabarre  has  demonstrated  conclusively,  that  it  is 
hollow,  and  there  is  reason  for  believing  that  as  the  tooth 
advances,  it  dilates  so  as  to  give  egress  to  the  tooth,  and 
ultimately  becomes  the  margin  or  free  edge  of  the  gum 
around  its  neck. 

This  is  the  only  theory  that  explains  upon  any  thing 
like  sound  philosophical  principles,  this  most  curious  and 
15 


110  OF    THE    DISEASES 

singular  operation  of  nature.  As  the  Editor  has  stated  in 
another  place,  he  repeats,  it  is  difficult  to  imagine  how  the 
elongation  of  the  pulp,  or  the  moulding  of  the  alveolar 
walls  to  it,  can  have  any  agency  in  raising  or  depressing 
a  tooth  through  the  gums.  If  the  elongation  of  the  pulp 
commenced  before  the  crown  of  the  tooth  had  made  any 
progress  toward  the  gums,  it  would  at  once  come  in  con- 
tact with  the  floor  of  the  alveolus,  and  in  its  soft  and 
yielding  condition,  be  caused  to  assume  a  configuration 
different  from  that  presented  by  the  root  of  a  naturally 
developed  tooth.  The  crown  of  the  tooth  must  there- 
fore make  some  progress  toward  the  gums,  before  the 
elongation  of  its  pulp  can  commence,  and  it  is  difficult  to 
conceive  how  this  can  be  effected,  if  it  is  not,  as  Dela- 
barre  supposes,  by  the  contraction  of  the  fibres  of  its 
sac] 

When  the  teeth  have  advanced  so  much  in  their  for- 
mation as  to  be  too  long  to  be  contained  in  the  socket, 
under  the  gum,  they  press  upon  the  membranes  which 
enclose  them;  these  become  absorbed,  and  then  the  pres- 
sure being  applied  against  the  gum,  that  also  is  removed, 
and  the  teeth  make  their  appearance.  When  the  absorp- 
tion of  the  membrane  and  gum  takes  place  early,  the 
child  suffers  no  inconvenience  during  the  progress  of 
dentition.  The  teeth  advance  without  any  trouble,  and 
their  appearance  is  discovered  by  the  mother  or  nurse 
with  some  degree  of  surprise:  but  when  the  growth  of 
the  teeth  is  too  rapid  for  the  absorption  of  the  gums, 
dentition  is  often  attended  with  much  pain  and  derange- 
ment of  the  whole  system.  At  this  early  period  of  life, 
as  I  have  already  observed,  the  constitution  is  so  delicate, 
and  the  irritability  so  great,  that  the  least  cause  of  irrita- 
tion produces  an  universal  sympathy  throughout  the 
whole  system.     It  is  well  known  to  many  adults,  that  the 


WHICH   ATTEND   DENTITION.  HI 

pain  attending  the  protruding  of  the  dentes  sapientiae  is 
very  great,  and  it  therefore  cannot  excite  surprise  that 
this  cause  of  irritation  should  in  children  produce  so 
many  distressing  symptoms,  and  even  be  the  cause  of 
destroying  so  many. 

When  the  formation  of  the  tooth  goes  on  very  rapidly, 
and  the  absorption  of  the  parts  which  cover  it  does  not 
proceed  in  proportion,  it  becomes  confined;  this  pro- 
duces a  distension  of  the  membrane,  and  occasions  pres- 
sure upon  the  pulp,  nerves  and  vessels  at  the  bottom  of 
the  socket.  The  tooth  continues  to  grow,  and  the  in- 
creased pressure,  which  is  occasioned  by  this  augmenta- 
tion, produces  inflammation,  and  a  variety  of  symptoms 
of  general  irritation. 

[If  the  theory  advanced,  just  before,  with  regard  to 
the  mechanism  of  dentition  be  correct,  and  that  it  is, 
seems  more  than  probable,  the  irritation  produced  by  it 
cannot  be  caused  by  pressure  of  the  tooth  upon  the  'pulp, 
nerves  and  vessels  at  the  bottom  of  the  socket,'  but  must 
result  from  inflammation  produced  by  the  pressure  of  the 
tooth  against  the  sac  and  superincumbent  gums.] 

Few  children  obtain  all  their  teeth  without  undergoing 
some  degree  of  suffering:  in  many,  the  symptoms  are 
merely  local,  in  others  they  often  arise  to  a  very  alarming 
height,  and  not  unfrequently  terminate  fatally. 

When  the  symptoms  are  merely  local,  the  gums  be- 
come very  tender,  and  look  redder  than  ordinary,  the 
child  is  restless,  and  rather  fretful:  these  symptoms  with 
some  children  are  of  short  duration,  and  always  go  off 
as  soon  as  the  tooth  appears.  Nature  operates  in  a  very 
salutary  manner  for  their  relief,  by  occasioning  an  in- 
crease in  the  secretion  of  the  saliva,  which  generally  is 
discharged  in  large  quantities,  and  thus  diminishes  the 
action  of  vessels.     In  other  cases  a  gentle  diarrhoea  takes 


112  OF    THE   DISEASES 

place,  which  also  reduces  the  state  of  irritability.  They 
also  find  relief  from  rubbing  or  pressing  the  gums,  which 
is  best  done  by  themselves.  The  coral,  though  used  as  a 
common  appendage  to  a  child's  dress,  is  a  very  injurious 
and  a  very  improper  substance:  children  ought  to  have 
nothing  hard;  they  will  put  their  fingers  into  the  mouth 
and  bite  upon  them;  or  they  may  have  a  soft  crust  of 
bread;  this  slight  pressure  will  expedite  the  absorption 
of  the  gum,  and  consequently  the  passage  of  the  tooth ; 
while  that  produced  by  a  harder  substance  will  increase 
the  irritation  and  inflammation. 

When  the  constitution  becomes  affected,  all  the  symp- 
toms of  general  irritation  occur,  and  there  is  scarcely  any 
affection  we  do  not  meet  with  in  one  case  or  other  of 
difficult  dentition. 

Fever  is  a  frequent  attendant,  and  it  often  comes  on 
very  suddenly;  at  first  there  is  a  heaviness  about  the 
eyes,  the  child  then  becomes  hot,  having  the  skin  dry 
and  tongue  white;  it  gets  very  restless,  putting  the  hand 
into  the  mouth,  and  can  neither  eat  nor  sleep.  Some- 
times these  symptoms  are  so  much  aggravated  that  de- 
lirium will  take  place,  and  convulsions  supervene. 

In  other  children,  the  skin  is  more  particularly  affected; 
a  little  fever  arises,  which  is  soon  followed  by  some  kind 
of  eruption.  There  are  several  appearances  seen  upon 
the  skin  during  childhood,  and  which  are  the  conse- 
quence of  irritation  during  the  time  of  dentition. 

A  very  common  eruption  is  a  rash,  which  resembles 
the  measles,  and  which  appears  in  spots  about  the  face 
and  neck,  sometimes  extending  over  other  parts  of  the 
body.  This  rash  is  like  an  aggregate  of  small  pimples, 
so  that  when  the  finger  is  pressed  over  the  red  part,  from 
the  skin  which  is  healthy,  a  small  rising  may  be  felt. 
This  has  been  called  the  red  gum,  and  is  very  common 


WHICH    ATTEND    DENTITION.  113 

to  children  during  the  early  months.  It  may  in  general 
be  esteemed  beneficial;  for  the  blood  being  carried  to  the 
skin,  takes  off  any  improper  determination  to  important 
parts,  and  prevents  more  serious  disease. 

Sometimes  postules  arise  in  different  parts  of  the  body; 
they  are  at  first  transparent,  from  being  filled  with  a 
limpid  fluid,  which  afterwards  becomes  purulent,  a  scab 
forms,  and  the  changes  afford  an  appearance  not  unlike  a 
mild  small-pox. 

There  are  other  eruptions  which  form  very  unpleasant 
and  extensive  scabs;  they  break  out  upon  the  corners  of 
the  mouth,  or  on  the  cheek.  Sometimes  they  begin 
upon  the  forehead,  and  spread  over  part  of  the  scalp; 
they  form  large  loose  scabs,  which  drop  off,  but  are  soon 
succeeded  by  others.  These  scabs,  however,  leave  no 
scar,  and  therefore  are  to  be  considered  only  as  trouble- 
some, and  not  dangerous. 

Other  children  are  subject  to  an  inflammation,  and  a 
discharge  from  behind  the  ears;  this  may  always  be  re- 
garded as  salutary,  since  from  its  contiguity  to  the  teeth, 
it  tends  to  divert  the  inflammation. 

A  gentle  diarrhoea,  during  teething,  is  a  beneficial  effort 
of  nature;  it  takes  off  the  excitement  from  the  constitution^ 
and  diminishes  the  febrile  symptoms.  But  sometimes  it 
becomes  so  excessive  as  to  produce  the  most  alarming 
symptoms;  the  discharges  are  of  a  green  colour,  very 
frequent,  and  attended  with  excessive  griping;  the  rest 
is  so  much  disturbed  that  no  strength  is  gained  by  it; 
the  child  is  continually  starting,  and  spasms  of  various 
parts  are  occasionally  seen;  at  length  the  whole  system 
becomes  so  reduced  that  convulsions  of  the  whole  body 
take  place,  which  continue  until  nature  becomes  com- 
pletely exhausted. 

In  some  children,  the  irritability  of  the  nervous  system 


114  OF    THE    DISEASES 

is  so  great,  that  convulsions  supervene  in  a  very  short 
time  after  the  appearance  of  any  febrile  symptom,  and 
this  is  constantly  the  case  with  the  cutting  of  every  tooth. 
Besides  these  different  affections,  there  are  so  many  other 
anomalous  symptoms,  that  it  may  be  truly  said,  that  every 
symptom  of  general  irritation  which  can  be  mentioned, 
may  be  met  with  during  the  time  of  dentition.  In  some 
children  the  lungs  are  much  affected,  and  they  are 
troubled  with  difficult  breathing;  in  others,  the  continual 
derangement  of  health  is  often  the  cause  of  scrofula, 
rickets,  or  consumption.  Mr.  Hunter  mentions  a  remark- 
able sympathetic  affection  in  a  child,  which  arose  from 
the  irritation  excited  by  teething.  Formerly  children 
were  often  placed  under  most  dangerous  circumstances, 
when  they  happened  to  be  attacked  with  the  small-pox  at 
the  same  time  as  they  suffered  from  dentition ;  but  happily 
now,  they  may  be  defended  from  that  dreadful  malady, 
by  the  shield  which  has  been  raised  by  the  admirable 
discovery  of  Dr.  Jenner;  and  we  have  the  certain  pros- 
pect, that  this  most  horrible,  of  human  maladies  is  about 
to  withdraw  its  pestilential  influence  from  the  world  for 
ever. 

In  the  treatment  of  any  affection  incident  to  children 
during  the  progress  of  dentition,  if  the  teeth  are  at  all 
suspected  to  be  concerned,  the  removal  of  the  cause  of 
irritation  ought  to  be  first  attended  to.  This  must  be 
done  by  opening  the  gum,  so  as  to  take  off  the  confine- 
ment from  the  tooth,  and  enable  it  to  pass  through.  This 
operation  ought  always  to  be  had  recourse  to  in  the  first 
instance,  and  then  other  remedies  should  be  applied  ac- 
cording to  the  various  symptoms  which  may  appear. 

When  there  is  fever,  the  antiphlogistic  regimen  must 
be  adopted.  The  bowels  should  be  evacuated.  The 
best   medicine   for   children   is  calomel,  which   may  be 


WHICH    ATTEND    DENTITION.  H5 

combined  with  rhubarb  or  scammony;    or  some  of  the 
neutral  salts  may  be  exhibited. 

After  these,  saline  draughts  or  gentle  antimonials  should 
be  administered,  in  order  to  produce  a  determination  to 
the  skin.  If  the  head  should  be  much  affected,  a  blister 
to  the  nape  of  the  neck  would  be  very  useful.  In  all 
cases  of  rash,  or  eruptions,  the  child  should  be  kept  warm, 
and  be  particularly  preserved  from  taking  cold,  as  great 
danger  often  follows  the  sudden  disappearance  of  any  af- 
fection of  the  skin.  If  this  should  happen,  the  child 
should  be  put  into  the  warm  bath,  and  some  medicines 
administered  to  produce  diaphoresis;  also  attention  is  to 
be  paid  to  the  bowels,  that  no  costiveness  be  suffered. 
In  general,  slight  eruptions  are  to  be  regarded  as  bene- 
ficial, and  particularly  those  occurring  behind  the  ears,  at- 
tended with  moderate  discharge.  In  cases  of  difficult 
dentition,  when  no  sore  ear  has  arisen  spontaneously, 
much  benefit  has  followed  the  practice  of  rubbing  a  small 
quantity  of  blister  ointment  behind  the  ears,  and  thus 
inducing  a  slight  discharge. 

If  scabs  are  extensive  and  become  dry  and  hard,  they 
may  be  wrashed  with  warm  milk  and  water,  and  touched 
with  a  little  oil.  They  also  may  occasionally  be  wetted 
with  the  hydrargyria  muriatus,  in  aqua  calcis,  in  the 
proportion  of  1  gr.  to  1  oz.:  the  scabs  should  never  be 
picked  off,  but  left  to  separate  of  themselves.  When 
they  extend  over  the  head  and  are  moist,  much  trouble 
and  pain  is  occasioned  by  the  sticking  of  the  cap;  they 
should  then  be  dusted  with  a  little  powder,  or  some  fine 
fuller's  earth,  and  a  singed  rag  should  be  laid  over  them. 
In  these  cases  much  good  has  been  seen  to  attend  the 
use  of  an  oiled  silk  cap,  or  a  piece  of  oiled  silk  laid  over 
the  part,  this  prevents  evaporation,  and  the  scabs  do  not 
dry  and  become  so  troublesome. 


116  OF    THE    DISEASES 

All  eruptions  are  to  be  regarded  as  salutary,  for  so 
great  a  sympathetic  connection  exists  between  the  skin 
and  the  stomach;  that  it  often  happens,  that  the  repelling 
of  any  eruption  from  the  skin,  immediately  produces 
considerable  derangement  of  that  organ,  which  ought  to 
be  regarded  as  a  sort  of  centre  of  sympathetic  action. 
This  is  very  strikingly  seen  in  a  variety  of  diseases  in 
which  the  stomach  sympathizes  with  the  other  parts  of 
the  body,  and  therefore  during  dentition  it  is  of  conse- 
quence not  to  check  any  mild  eruption  which  may  appear. 

If  a  diarrhoea  be  only  moderate,  it  should  not  be 
checked;  it  tends  to  diminish  fever,  and  takes  off  the 
excitement  from  the  constitution.  As  it  is  usually  con- 
nected with  acidity,  a  little  magnesia,  or  some  of  the  tes- 
taceous powders  may  be  exhibited;  but  when  the  diar- 
rhoea runs  on  for  a  great  length  of  time,  and  seems  to  be 
causing  weakness,  which  threatens  fatal  atrophy,  serious 
endeavours  must  be  made  to  subdue  it. 

The  treatment  of  this  complaint  is  attended  with  many 
difficulties,  and  medicines  which  succeed  in  some  cases 
will  totally  fail  in  others.  If  the  abdomen  be  much  en- 
larged, two  grains  of  calomel  every  night,  purged  off  in 
the  morning  with  ten  grains  of  rhubarb  and  half  the 
quantity  of  magnesia,  will  generally  be  found  beneficial. 
This  should  not  be  persevered  in  more  than  three  or  four 
days  successively,  and  should  be  succeeded  by  eight 
grains  of  the  pulvis  cretce  comp.  cum  opio,  and  four  or  five 
grains  of  columba  root.  The  patient  should  be  warmly 
clothed,  especially  on  the  abdomen  and  lower  extremi- 
ties. On  some  occasions  the  pulv.  trag.  comp.  appears 
preferable  to  the  pulv.  cretce  comp.;  and  the  syrup,  or 
decoct.  althcBy  with  20  drops  of  paregoric  elixir,  have  suc- 
ceeded when  the  other  usual  means  have  failed.  The 
warm  bath  may  be  considered  as  another  perfect  species 


WHICH    ATTEND    DENTITION.  117 

of  warm  clothing,  and  is  attended  wTith  good  effects,  by 
relaxing  the  pores  of  the  skin  and  relieving  the  bowels. 
If  the  above  mentioned  remedies  cannot  be  taken  by  the 
patient,  opiate  frictions  of  the  abdomen  or  back  should  be 
used,  and  the  following  formula  will  answer  very  conve- 
niently. R.  Ung.  hydr.  fort.  5i. — pulv.  opii  pur i.  Gi. 
old  oliv.  3  iij.  fiat  linimentum  bis  terve  in  hebdomade  in- 
fric;  but  the  quantity  and  repetition  must  be  regulated 
by  the  judgment  of  the  practitioner.  If  the  patient  is 
much  distressed  by  tenesmus  and  stools  streaked  with 
blood,  clysters  of  starch,  with  20  drops  of  tr.  opii,  and 
twice  that  number  of  tr.  catechu  or  kino,  should  be  given 
every  evening. 

When  convulsions  have  taken  place,  we  must  endea- 
vour to  remove  what  appears  to  be  the  exciting  cause. 
If  the  stomach  have  been  overloaded  with  improper  food; 
or  there  be  signs  of  indigestion,  a  gentle  emetic  should 
be  given.  If  there  is  costiveness,  or  the  bowels  are  af- 
fected, they  should  be  cleansed  by  a  clyster:  when  the 
stools  are  offensive,  or  the  breathing  at  all  affected,  a  few 
grains  of  calomel  and  scammony  may  be  given  with  ad- 
vantage. If  those  medicines  do  not  succeed,  antispas- 
modics should  be  administered.  It  often  happens  that 
the  deglutition  is  much  affected,  then  it  will  be  right  to 
give  an  enema  with  asafoetida:  or  if  not,  in  a  draught,  a 
drop  or  two  of  tinct.  opii  should  be  given.  The  back 
may  be  rubbed  with  oil  of  amber,  or  aqua  ammonias. — 
During  the  fit  it  is  always  proper  to  put  the  lower  parts 
of  the  body  into  warm  water,  which  by  exciting  a  greater 
flow  of  blood  to  the  legs,  takes  off  too  great  a  determina- 
tion to  the  head;  a  blister  should  be  applied  to  the  back 
of  the  neck,  and  leeches  may  be  applied  to  the  temple. 

Other  symptoms  which  arise,  must  be  met  according  to 
their  urgency;  but  we  ought  never  to  lose  sight  of  what 
16 


118  OF    THE    DISEASES 

may  appear  to  be  the  principal  exciting  cause,  viz.  the 
inability  of  some  teeth  to  pass  through  the  gums. 

Under  every  circumstance  of  indisposition,  arising  from 
dentition,  the  lancing  of  the  gums  ought  never  to  be  omit- 
ted. The  benefit  which  attends  the  operation  is  so  sud- 
den, and  if  performed  sufficiently  early,  is  so  certain,  that 
it  ought  never  to  be  neglected.  As  soon  as  the  gum  is 
lanced  and  the  membrane  is  divided,  the  tooth  obtains  an 
increase  of  room,  the  pressure  is  immediately  taken  off 
from  the  socket,  and  the  cause  of  irritation  is  removed. 

It  is  very  surprising  that,  notwithstanding  the  manifest 
advantage  which  attends  the  lancing  of  the  gums,  in  cases 
of  painful  dentition,  there  are  persons  who  entertain  strange 
prejudices  against  this  safe  and  important  source  of  relief. 
But  the  uniform  experience  of  its  good  effects,  and  no  in- 
stance of  its  doing  harm  ever  having  occurred,  should 
produce  an  unanimous  consent  for  adopting  it.  Some 
persons  object  to  the  operation  on  account  of  the  pain 
which  it  will  occasion  to  the  child,  not  considering  that 
the  inflammation  produced  by  the  resistance  of  the  gum 
to  the  tooth,  is  far  more  acute  than  dividing  the  gum  with 
a  sharp  instrument.  Others  suppose  that  the  formation 
of  the  teeth  is  injured,  and  that  they  are  more  liable  to 
decay;  but  neither  of  these  circumstances  can  occur;  for 
at  the  time  that  the  teeth  is  about  to  pass  through,  the 
enamel  is  completely  formed,  and  no  injury  can  be  done 
to  the  formation  of  the  fang,  which  is  always  continued 
for  some  time  after  the  appearance  of  the  crown. 

When  it  is  necessary  to  lance  the  gums  some  time  be- 
fore the  teeth  are  quite  ready  to  appear,  they  unite,  and 
in  this  case  the  cicatrix  has  been  said  to  impede  the  pro- 
gress of  the  tooth,  presenting  a  greater  resistance  than  the 
gums  in  their  natural  state;  but  it  is  now  certainly  known 
that  a  newly  formed  part  always  gives  way  sooner  to  the 


WHICH    ATTEND    DENTITION.  119 

process  of  absorption  than  the  surrounding  parts,  and 
hence  the  passage  of  the  tooth  is  facilitated. 

The  haemorrhage  which  is  occasioned  by  the  operation 
is  never  considerable,  but  is  always  beneficial;  the  vessels 
become  unloaded,  and  the  inflammation  is  always  soon 
diminished. 

The  most  convenient  instrument  for  this  purpose  is  a 
round  edged  gum  lancet;  this  cuts  much  easier  than  a 
pointed  one.  It  is  necessary  that  the  tooth  be  felt  with 
the  edge  of  the  instrument,  else  the  membrane  may  still 
be  left  upon  the  stretch,  and  no  other  benefit  be  derived 
than  that  which  proceeds  from  the  topical  bleeding.  In 
lancing  the  incisores  it  will  be  proper,  in  dividing  the 
gum,  to  pass  the  lancet  down  on  the  anterior  part  of  the 
tooth :  for  if  it  be  carried  deep  on  the  posterior  part  ol 
the  tooth,  there  may  be  a  danger  of  dividing  the  membrane 
which  connects  the  pulps  of  the  permanent  teeth  to  those 
of  the  temporary,  and  the  formation  of  the  former  may 
be  injured.*  [When  the  incision  is  made  directly  through 
the  summit  of  the  gums  covering  the  alveolar  ridge,  the 
lancet  passes  behind  the  teeth,  and  to  prevent  which  it 
should  be  made  about  the  twelfth  or  sixteenth  part  of 
an  inch  anterior  to  it.] 

When  the  gums  of  the  molares  are  to  be  lanced,  a 
crucial  incision  may  be  made,  or  two  semilunar  incisions, 
the  gums  soon  separate,  and  the  tooth  shortly  makes  its 
appearance.  The  symptoms  which  usually  precede  any 
indisposition  arising  from  teething  ought  to  be  universally 
known,  because  then  the  certain  remedy  may  be  applied 
in  time,  and  a  great  deal  of  suffering  be  spared  to  the 
child.  If  the  nurse  be  attentive,  she  will  find  the  child 
does  not  take  the  nipple  with  the  same  degree  of  force 
as  ordinary,  or  it  holds  it  only  for  a  short  time,  and  soon 

*  Plate  IX.  Fie.  5. 


120  OF    THE    DISEASES 

lets  it  go;  the  gums  feel  hot,  and  are  redder  than  usual; 
the  cheeks  appear  flushed,  the  eyes  look  heavy,  and  the 
child  is  uneasy.  When  these  symptoms  appear,  the 
mouth  should  be  examined,  and  if  there  be  any  fulness 
of  the  gums,  or  they  have  the  appearance  of  inflammation, 
they  should  be  lanced  at  that  part.  The  order  in  which 
the  teeth  appear  should  always  be  kept  in  mind,  and  then 
there  will  be  little  probability  of  mistake,  as  to  the  spot 
where  the  cause  of  irritation  is  seated. 

As  a  child  increases  in  strength,  the  symptoms  arising 
from  dentition  diminish,  and  often  become  merely  local; 
but  the  diseases  to  which  infants  are  liable,  frequently 
keep  them  in  weak  health,  and  much  disposed  to  be  af- 
fected by  any  exciting  cause  of  irritation. 

To  delicate  children  there  is  often  danger  attending 
the  cutting  of  the  cuspidati  and  the  first  molares.  These 
teeth  advance  in  growth  nearly  at  the  same  time,  so  that 
there  are  eight  teeth  making  pressure  upon  the  mem- 
branes and  the  gums  at  the  same  period.  If  at  this  time 
a  child  should  be  at  all  indisposed,  one  or  other  of  these 
teeth  may  be  the  cause  of  convulsions,  or  some  other  se- 
rious disease;  therefore,  when  any  of  these  teeth  appear 
to  be  in  a  state  of  forwardness,  the  gum  should  be  lanced. 
This  is  the  only  method  of  treatment  to  be  relied  on  to 
bring  a  weakly  child  through  this  period. 

During  the  second  dentition,  with  one  exception, 
scarcely  any  pain  is  felt;  the  constitution  has  acquired  such 
a  degree  of  strength  that  the  sympathetic  action  is  with 
more  difficulty  excited,  and  the  only  inconvenience  ever 
experienced  is,  when  the  permanent  teeth,  which  are 
placed  at  the  base  of  the  temporary  ones,  by  the  increase 
of  their  growth  make  pressure  against  them;  this  more 
particularly  happens  when  the  bicuspides  are  endeavouring 
to  come  forward,  and  being  resisted,  by  the  continuance 


WHICH    ATTEND    DENTITION.  ]21 

of  the  temporary  molares,  a  tenderness  and  pain  are  occa- 
sioned, which  can  only  be  relieved  by  extracting  the  tem- 
porary teeth,  and  thus  giving  way  for  the  passage  of  the 
permanent. 

The  exception  to  which  I  have  alluded  with  respect  to 
pain  during  the  second  dentition,  is  in  the  clentes  sapien- 
tiae;  very  often  a  great  deal  of  pain  attends  the  progress 
of  these  teeth.  When  there  is  scarcely  sufficient  space 
for  them  to  grow,  or  the  gum  being  very  thick  is  firmly 
bound  over  them,  considerable  inflammation,  and  some- 
times swelling  of  the  face  takes  place.  In  many  cases  the 
pain  is  so  severe  as  to  excite  a  considerable  degree  of  fe- 
ver and  indisposition.  I  have  known  persons  confined 
from  this  cause  only,  during  several  weeks.  If  the  clen- 
tes sapientioe  of  the  upper  jaw  pass  through  first,  it  very 
much  increases  the  inflammation,  because  whenever  the 
mouth  is  closed,  the  gums  which  cover  the  teeth  in  the 
under  jaw  are  bitten  upon  by  the  upper,  and  being  con- 
tinually pinched,  the  patient  suffers  extremely. 

Generally  it  is  only  necessary  to  lance  the  gums  with  a 
crucial  incision;  there  is  often  a  good  deal  of  hemorrhage, 
which  is  very  useful  in  reducing  the  inflammation;  the 
gum  soon  retracts,  and  the  tooth  gradually  passes  through. 
When  the  upper  clentes  sapientiae  appear  first,  it  is  some- 
times necessary  to  cut  off  the  piece  of  gum  which  covers 
the  under  tooth. 

In  many  cases  the  gum  is  very  thick,  and  will  often 
close  and  unite  again  after  the  operation;  this  produces  a 
necessity  for  repeating  it;  but  which  might  always  be  pre- 
vented, by  inserting  a  small  piece  of  lint  between  the 
edges  of  the  divided  gum,  which  then  cannot  unite;  they 
remain  separated,  and  gradually  receding,  the  tooth  has 
no  longer  any  obstruction. 

Sometimes,  in    these   cases    the    gum    is   exceedingly 


122       DISEASES    WHICH    ATTEND    DENTITION. 

swelled  over  the  toothy  and  when  divided  by  the  lancet, 
a  considerable  quantity  of  glairy  fluid  escapes;  in  some 
instances  I  have  met  with  considerable  quantity  of  matter, 
and  in  one  case  the  gum  was  ulcerated  to  a  great  extent. 
[But  neither  lancing  the  gums  nor  cutting  out  a  piece 
from  over  the  tooth,  will  always  afford  relief,  the  extrac- 
tion of  the  tooth  itself  is  often  necessary,  or  the  antagoniz- 
ing one  in  the  other  jaw,  which,  having  made  its  appear- 
ance first,  strikes  the  gums  covering  this,  at  each  occlusion 
of  the  mouth,  causing  it  to  inflame  and  swell  and  often- 
times to  become  exceedingly  painful.  The  extraction  of 
the  second  molaris  wrill  generally  give  relief,  and  when 
this  is  very  much  decayed,  it  is  better  to  remove  it,  than 
the  dens  sapientiae.  So  great  is  the  irritation  sometimes 
produced  by  the  dentition  of  these  teeth,  that  trismus  has 
been  known  to  result  from  it.  Two  cases  of  this  sort 
have  fallen  under  my  own  observation.  In  cases  of  this 
sort,  the  treatment  should  be  addressed  to  the  general 
system.  Copious  bleeding,  warm  bath  and  small  doses  of 
emetic  tartar  should  be  had  recourse  to,  for  the  purpose 
of  inducing  a  relaxation  of  the  muscles  of  the  jaw,  and 
so  soon  as  this  is  accomplished,  the  tooth  should  be  ex- 
tracted.] 


CHAPTER    ELEVENTH. 

Being  desirous  to  render  this  work  as  complete  as 
possible,  I  requested  the  favour  of  my  friend,  Mr.  Pepys, 
to  make  a  chemical  analysis  of  the  teeth,  and  from  the 
accuracy  with  which  all  his  experiments  are  conducted, 
I  flatter  myself  that  the  following  observations  will  not 
a  little  enhance  the  value  of  the  publication. 

THE   ANALYSIS   OF   HUMAN  TEETH. 

BY    W.    H.    PEPYS,    JR. 

Mr.  Charles  Hatchet,  in  his  valuable  paper  on  shell  and 
bone,  [Phil.  Transact,  for  1799]  enumerated  the  several 
substances  which  enter  into  the  composition  of  the  human 
teeth;  it  is  to  be  regretted  that  the  nature  of  his  subject 
did  not  render  it  necessary  for  him  to  ascertain  the  pro- 
portions in  which  they  are  respectively  found,  as  it  could 
not  have  failed  to  have  proved  highly  useful,  and  his 
known  accuracy  would  have  precluded  the  necessity  of 
any  other  person  undertaking  such  a  labour.  Several 
good  analyses  of  bone  have  been  published,  but  I  believe 
no  accurate  analysis  of  the  teeth  has  yet  been  offered. 

Bone,  it  has  been  observed,  when  exposed  to  the  ac- 
tion of  acid  menstrua,  becomes  dissolved;  that  is  to  say, 
the  solid  or  constituent  substance  of  them  is  abstracted, 
and  a  gelatinous  matter  is  left  of  the  form  of  the  original 
bone. 


124  THE    ANALYSIS    OF    HUMAN    TEETH. 

Nitric,  muriatic,  and  acetic  acids  are  capable  of  produ- 
cing this  change,  which  is  accompanied  with  a  liberation 
of  an  aeriform  fluid,  that  precipitates  lime  in  lime  water, 
changes  vegetable  blues  red,  and  by  its  gravity  is  known 
to  be  carbonic  acid  gas.  These  acid  solutions  yield  a  co- 
pious precipitate  with  pure  ammonia,  which  is  again  solu- 
ble in  either  of  the  acids.  After  the  precipitation  by  pure 
ammonia,  the  solution  of  the  carbonate  of  ammonia  will 
still  produce  a  new  precipitate. 

The  precipitate  of  the  first  solution,  by  pure  ammonia, 
as  noticed  above,  is  soluble  again  in  the  acids  before  men- 
tioned; these  solutions  yield,  with  a  solution  of  acetite  of 
lead,  a  copious  precipitate,  proving  the  presence  of  phos- 
phoric acid. 

The  precipitate  obtained  by  the  carbonate  of  ammonia 
is  also  soluble  in  either  of  the  above  acids,  but  with  effer- 
vescence; and  these  solutions  are  not  precipitated  by  ace- 
tite of  lead;  they  fall,  however,  with  oxalate  of  ammonia, 
carbonate  of  ammonia,  or  any  precipitant  of  lime. 

The  great  solubility  of  the  phosphate  of  lime,  in  even 
the  weakest  of  the  acids,  is  very  extraordinary.  Phos- 
phate of  lime  mechanically  suspended  in  water,  is  speedily 
and  completely  dissolved  by  passing  a  copious  stream  of 
carbonic  acid  gas  through  it. 

With  these  facts  before  me,  I  have  ventured  to  exam- 
ine the  several  specimens  of  the  human  teeth;  as  the 
enamel,  the  bone,  or  roots,  the  teeth  of  adults,  and  the 
shedding  teeth  of  children. 

Previous  to  an  account  of  the  analysis,  it  may  not  be 
uninteresting  to  notice  the  action  of  some  of  the  articles 
of  the  materia  chemica  on  the  teeth. 

Sulphuric  acid,  of  the  specific  gravity  1.83,  appears  at 
first  to  have  no  action;  in  the  course  of  an  hour  small 
bubbles  are  perceived,  the  roots  become  blackened,  and 


ANALYSIS    OF    THE    ENAMEL.  125 

in  twelve  hours  the  enamelled  part  bursts,  cracks,  and 
separates,  accompanied  with  an  evident  formation  of  sele- 
nite,  by  the  action  of  the  acid  on  the  lime,  which  enters 
into  the  composition  of  the  teeth. 

Nitric  and  muriatic  acids  of  the  specific  gravity  of  1.12, 
act  instantly  on  the  tooth,  accompanied  with  an  evolution 
of  a  quantity  of  small  air  bubbles  from  the  wdiole  of  the 
surface;  about  eight  times  their  weight  of  these  acids  are 
sufficient  for  the  solution  of  the  solidifying  principles  of 
the  teeth.  The  mass  left  undissolved  has  nearly  the  ori- 
ginal form  of  the  tooth,  is  flexible,  semi-transparent,  and 
easily  divided  by  the  nail. 

The  dilute  acetous  acid  (distilled  vinegar)  has  a  very 
trifling  action,  but  when  concentrated,  acts  both  on  the 
phosphate  and  carbonate  of  lime. 

Boiling  nitric  acid  acts  strongly  on  a  tooth,  with  the 
evolution  of  carbonic  acid,  and  a  considerable  quantity  of 
azotic  gas.  The  gelatine  and  solid  substance  are  dis- 
solved as  the  surfaces  present  themselves;  but  the  opera- 
tion being  stopped  at  any  part  of  the  process,  the  resi- 
duum is  firm  and  hard,  but  reduced  in  size  proportioned 
to  the  time  the  tooth  has  been  acted  upon. 


ANALYSIS   OF   THE   ENAMEL. 

One  hundred  grains  of  the  enamel  of  human  teeth, 
(carefully  rasped)  were  placed  in  600  grains  of  nitric 
acid  of  the  specific  gravity  of  1.12.  Slight  effervescence 
ensued,  and  after  twelve  hours  200  grains  more  of  the 
acid  were  added.  Allowing  for  the  loss  by  evaporation 
in  a  corresponding  vessel,  after  thirty-six  hours  it  was 
found  to  have  lost  four  grains  and  a  half. 
17 


126  ANALYSIS    OF    THE    ENAMEL. 

It  was  then  diluted  with  four  ounces  of  distilled  water, 
precipitated  by  pure  ammonia,  and  then  filtered. 

The  precipitate  obtained  being  dried  in  a  water  bath, 
at  212°,  weighed  102  grains.  It  was  then  ignited,  after 
wThich  it  was  found  to  weigh  78  grains. 

The  filtered  solution  was  then  precipitated  by  carbo- 
nate of  ammonia  in  solution,  and  filtered : 

The  separated  precipitate  being  dried  in  a  heat  of  212°, 
weighed  six  grains.     Enamel  then  consists  of 

Phosphate  of  lime,        ...         78 
Carbonate  of  lime,         ...  6 

~84 
Water  of  composition  and  loss,      .         16 

100 
A  loss  of  16  grains  here  takes  place,  which  is  easily  ac- 
counted for,  from  the  impossibility  of  directly  ascertaining 
the  state  of  dryness  in  which  the  ingredients  existed 
originally  in  the  enamel;  for  we  have  seen,  that  by  drying 
the  phosphate  of  lime  in  a  heat  of  212°,  (after  which  it 
had  the  appearance  of  being  as  dry  as  possible)  it  yet 
contained  so  much  moisture,  as  to  yield  a  gain  of  8  grains 
in  the  analysis. 

On  the  other  hand,  when  ignited,  its  state  is  driven  to 
the  opposite  extreme,  and  there  is  a  loss  of  16  grains.  It 
is  impossible,  however,  that  the  materials  could  exist  in 
the  teeth,  in  a  state  of  dryness  to  be  compared  with  that 
produced  by  exposing  them  to  such  a  high  temperature. 
And  it  appears  but  reasonable  to  conclude,  that  the  real 
quantity  of  moisture  lies  nearer  to  that  given  by  the  heat 
of  212°,  than  to  that  given  by  ignition,  and  consequently 
that  the  16  grains  lost  by  exposure  to  such  a  high  tem- 
perature, were  chiefly  water. 


ANALYSIS    OF    THE    ENAMEL.  127 

Bone,  or  roots  of  teeth,  yielded  by  analysis  in  100  grs.; 
Phosphate  of  lime,         ...         58 
Carbonate  of  lime,         ...  4 

Gelatine,       .....         28 

90 
Water  of  composition  and  loss,      .         10 

100 

The  teeth  of  adults  yielded  on  analysis  in  100  grains, 

Phosphate  of  lime,         ...         64 

Carbonate  of  lime,         ...  6 

Gelatine, 20 

90 

Water  of  composition  and  loss,        .         10 

100 
Specific  gravity  of  adults'  teeth,         .         2.2727. 
The  shedding,  or  primary  teeth  of  children,  yielded  on 
analysis  in  100  grains, 

Phosphate  of  lime,        ...         62 
Carbonate  of  lime,         ...  6 

Gelatine, 20 

88^- 
Water  of  composition  and  loss,       .         12 

100 
Specific  gravity  of  children's  teeth,     .        2.0833. 

In  these  analyses,  as  in  the  former,  the  phosphate  of 
lime  was  also  exposed  to  a  red  heat,  and  consequently 
was  reduced  to  a  greater  degree  of  dryness  than  that  in 
which  it  existed  in  the  tooth. 

In  all  of  them  the  carbonate  of  lime  was  dried  in  a  heat 
of  212°  (above  which  it  would  have  been  liable  to  de- 
composition) and  the  gelatine  of  the  three  last  in  the 
same  temperature. 


EXPLANATION  OE  PLATES 


TO 


PART  FIRST. 


PLATE  I 


THE  RUDIMENTS  OF  THE  ALVEOLAR  PROCESSES  AND  THE 
PULPS  OF  THE  TEETH. 

Fig.  1.  The  under  jaw  of  a  foetus  at  three  or  four 
months.  In  the  anterior  part,  processes  of 
bone  are  shooting  across  to  form  the  alveoli 
for  the  incisores. 

Fig.  2.  The  gums  removed  from  the  same  jaw  bone, 
exhibiting  the  first  appearance  of  the  pulps, 
those  of  the  incisores  being  the  most  distinct. 

Fig.  3.  The  under  jaw  of  a  fetus  at  six  months,  in 
which  the  alveolar  processes  are  seen  more 
advanced. 

Fig.  4.  The  pulps  removed  from  the  same  jaw,  dis- 
tinctly formed,  each  contained  within  its  pro- 
per membrane. 

Fig.  5,  6.  The  upper  jaws  of  fetuses  of  the  same  age, 
as  in  Fig.  1,  2;  exhibiting  the  alveolar  pro- 
cesses and  pulps. 


PLATE  II. 


THE  PROGRESS  IN  THE  FORMATION  OF  THE  TEETH  FROM  THE 
TIME  OF  BIRTH,  UNTIL  BETWEEN  TWO  AND  THREE  YEARS 
OF  AGE. 

*#*  The  figures  on  the  left  side  of  the  plate  represent 
the  teeth  as  naturally  situated ;  those  on  the  right  side  as 
taken  out  from  the  sockets;  the  dotted  lines  represent 
the  gums. 
Fig.  1.  The  teeth  at  the  time  of  birth,  when  they  are 

only  shells,  having  the  form  of  the  crowns  of 

teeth. 

a.  The  central  incisores. 

b.  The  lateral  incisores. 

c.  The  cuspidati. 

d.  The  first  molares. 

e.  The  second  molares. 

A.  Points  of  ossification  upon  the  tips  of  the  pulps 

of  the  permanent  incisores. 

B.  Points  of  ossification  upon  the  points  of  the  per- 

manent molares. 
Fig.  2.  The  teeth  of  a  child  about  six  or  eight  months 
after  birth.  At  this  time  the  central  incisores 
of  the  upper  jaw,  and  the  central  and  lateral 
incisores  of  the  lower  jaw,  have  made  their 
appearance;  the  other  teeth  are  considerably 
advanced  in  growth. 


PLATE    II.  133 

a  b  c  d  e.  The  temporary  teeth. 

A.  The  permanent  central  incisores. 

B.  The  permanent  lateral  incisores. 

C.  The  permanent  cuspidatus  of  the  lower  jaw. 

D.  The  first  permanent  molares. 

Fig.  3.  The  teeth  of  a  child  at  sixteen  months.  The 
incisores  in  each  jaw,  and  the  first  molares, 
have  passed  through  the  gums. 

A.  The  permanent  incisores  much  increased. 

B.  The  cuspidati. 

C.  The  first  permanent  molares. 

Fig.  4.  The   temporary   set   of  teeth   have  all   passed 
through  the  gums;  and  in  addition  to  the  per- 
manent teeth  already  described  are; 
A  A.  The  points  of  the  first  bicuspides. 


18 


PLATE  III.* 

THE    TEETH    OF    A    CHILD    BETWEEN    FOUR    AND   FIVE   YEARS 

OF    AGE. 

Fig.  1.  A  side  view.         Fig.  2.  A  front  view. 

Of  the  temporary  set. 
acta  a.  The  central  incisores. 
bbbb.  The  lateral  incisores. 
c  c  c  c.  The  cuspidati. 
dd  dd.  The  molares. 

Of  the  permanent  set. 
e  e  e  e.  The  central  incisores. 
ffff  The  lateral  incisores. 
g  g  g  g.  The  cuspidati. 
hhhh.  The  first  bicuspides. 
iiii.  The  first  molares. 
k  k.  The  second  molares. 

The  formation  of  the  second  bicuspides  has  not  yet 
commenced. 

*  For  the  references  to  this  Plate,  and  Plates  IV.  and  V.  see  the  outline  Plate  VI. 


PLATE  IV. 

THE  TWO   SETS   OF   TEETH  AT   SIX  YEARS    OF   AGE. 

Fig.  3.  of  Plate  VI. 

Of  the  temporary  set. 
aaaa.  The  central  incisores. 
bbbb.  The  lateral  incisores. 
c  c  c  c.  The  cuspidati. 
dddd.  The  molares. 

Of  the  permanent  set. 
e  e  e  e.  The  central  incisores. 
ff.  The  lateral  incisores. 
g  g  g  g.  The  cuspidati. 
hhhh.  The  first  and  second  bicuspides. 
i  i.  The  first  molares. 
k  k.  The  second  molares. 


PLATE  V. 

THE  TEETH  AT  EIGHT  OR  NINE  YEARS  OF  AGE.  THE  INCI- 
SORES  HAVE  BEEN  CHANGED,  AND  THE  FIRST  PERMANENT 
MOLARES  HAVE  APPEARED. 

Fig.  4.  of  Plate  VI. 

Of  the  temporary  set. 
a  a.  The  cuspidati. 
bbbb.  The  molares. 

Of  the  permanent  set. 
c  c  c  c.  The  central  incisores. 
dddd.  The  lateral  incisores. 

e  e.  The  cuspidati. 
ffff  The  bicuspides. 
g  g.  The  first  molares. 
h  h.  The  second  molares. 
i  i.  The  third  molares,  or  dentes  sapien- 
tiae;  beginning  to  form. 


HATE  VII. 


(FROM  GOODSIR.) 

Fig.  1.  Mucus  membrane. 

Fig.  2.  Mucus  membrane  with  a  granular  mass  rising  up 
from  it. 

Fig.  3.  Primitive  dental  groove. 

Fig.  4.  A  papilla  on  the  floor  of  the  groove. 

Fig.  5.  The  papilla  enclosed  in  a  follicle,  and  the  se- 
condary dental  groove  forming. 

Fig.  6.  The  papilla  assuming  the  shape  of  a  pulp,  the 
opercula  forming  and  a  depression  for  a  cavity 
of  reserve  behind  the  inner  operculum. 

Fig.  7.  The  papilla  after  it  has  become  a  pulp,  the  follicle 
a  sac  by  the  adhesion  of  the  lips  of  the  oper- 
cula, and  the  secondary  dental  groove  in  the 
act  of  closing. 

Fig.  8.  The  secondary  groove  adherent,  except  behind 
the  inner  operculum,  where  there  remains  a 
shut  cavity  of  reserve  for  the  formation  of  the 
pulp  and  sac  of  the  permanent  tooth. 

Fig.  9.  The  last  change  more  complete  by  the  deposition 
of  the  granular  body,  deposition  of  tooth-bone 
commencing. 

Fig.  10.  The  cavity  of  reserve  receding,  its  bottom  in 
which  the  pulp  is  forming  dilating. 

Fig.  11.  The  cavity  of  reserve  becoming  a  ^ac  with  a 


138  PLATE    VII. 

pulp  at  its  bottom,  and  further  removed  from 
the  surface  of  the  gum;  the  temporary  tooth 
covered  with  a  layer  of  bone,  and  the  granular 
substance  absorbed. 

Fig.  12.  The  temporary  tooth  getting  its  fang,  and  ap- 
proaching the  surface  of  the  gum. 

Fig.  13.  Root  of  the  temporary  tooth  longer,  and  its  sac 
touching  the  surface  of  the  gum. 

Fig.  14.  Eruption  of  the  temporary  tooth;  its  sac  again 
a  follicle,  and  the  permanent  receding  further 
from  the  surface  of  the  gum. 

Fig.  15.  Completion  of  the  temporary  tooth;  free  portion 
of  the  sac  become  the  vascular  margin  of  the 
gum,  and  the  permanent  sac  connected  by  a 
chord  passing  through  the  alveolo-dental  canal 
or  foramen. 

Fig.  16.  Lengthening  of  the  root  of  the  permanent  tooth, 
the  crown  approaching  the  gum,  and  the  root 
of  the  temporary  tooth  partly  destroyed. 

Fig.  17.  The  changes  last  described  more  advanced. 

Fig.  18.  The  eruption  of  the  permanent  tooth,  and  the 
molting  of  the  temporary. 

Fig.  19.  The  permanent  tooth  perfected. 

Fig.  20.  The  primitive  dental  groove  in  its  non-adherent 
state. 

Fig.  21.  The  papilla  and  follicle  of  the  first  molaris  on 
the  floor  of  the  non-adherent  portion  of  the 
groove,  now  become  the  secondary  groove. 

Fig.  22.  The  papilla  a  pulp,  and  the  follicle  a  sac,  and 
the  lips  of  the  secondary  groove  adhering,  so 
that  the  latter  has  become  the  posterior  or 
great  cavity  of  reserve. 

Fig.  23.  The  sac  of  the  first  molar  increased  in  size,  ad- 
vancing into  the  coronoid  process  or  maxillary 


PLATE    VII.  139 

tuberosity,  and  the  cavity  of  reserve  length- 
ened. 
Fig.  24.  The  sac  of  the  first  molaris  returning  by  the 

same  path  to  its  former  position,  and  the  cavity 

of  reserve  shortening. 
Fig.  25.  The  cavity  of  reserve  sending  backwards  the 

sac  of  the  second  molaris. 
Fig.  26.  The  sac  of  the  second  molaris  passing  into  the 

coronoid  process  or  maxillary  tuberosity. 
Fig.  27.  The  second  molar  sac  returned,  and  the  cavity 

of  reserve  shortened. 
Fig.  28.  The  cavity  of  reserve  sending  off  the  sac  and 

pulp  of  the  wisdom  tooth. 
Fig.  29.  The  sac  of  the  wisdom  tooth  advanced  into  the 

coronoid  process  or  maxillary  tuberosity. 
Fig.  30.  The  sac  of  the  wisdom  tooth  returned  to  the 

extremity  of  the  dental  range. 


PLATE  VIII. 

Fig.  1.  The  permanent  set  of  teeth  complete. 
Row  1.  The  temporary  teeth  of  the  upper  jaw. 
Row  2.  The  permanent  teeth  of  the  upper  jaw, 
Row  3.  The  permanent  teeth  of  the  lower  jaw. 
Row  4.  The  temporary  teeth  of  the  lower  jaw. 


PLATE   IX. 

Fig.  1.  Longitudinal  sections  of  teeth,  the  bony  part 
of  which  has  been  burnt,  to  render  the  distri- 
bution of  the  enamel  more  conspicuous. 

Fig.    2.     The  transverse  section  of  a  molaris. 

Fig.  3.  A  tooth  magnified,  to  exhibit  the  striated  ap- 
pearance of  the  enamel. 

Fig.  4.  An  under  jaw,  the  fore  part  of  which,  and  of 
the  teeth,  have  been  sawn  away  to  shew  the 
cavities  in  the  teeth. 

Fig.  5.  A  section  of  the  under  jaw;  the  nerve  is  seen 
giving  off  branches  which  enter  the  cavities 
of  the  teeth. 

Fig.    6.     A  molaris  of  the  under  jaw,  having  three  fangs. 

Fig.  7.  A  molaris  having  on  its  side  a  deposit  of  enam- 
el like  a  pearl. 

Fig.  8.  The  central  incisores  of  the  under  jaw  united 
at  the  sides. 

Fig.  9.  Two  views  of  the  second  and  third  molares  of 
the  upper  jaw,  which  are  united  by  the 
inner  fangs. 

Fig.  10.  A  molaris  of  the  under  jaw,  having  the  crown 
of  a  bicuspis  growing  out  of  its  side. 

Fig.  1 1.     A  molaris  of  the  under  jaw,  having  four  fangs. 

Fig.  12.     The  permanent  central  incisores  of  the  under 
jaw,  having  an  exceedingly  deformed  appear- 
ance. 
19 


142  PLATE    IX. 

Fig.  13.     A  molaris  of  the  upper  jaw;  having  five  fangs. 

Fig.  14.  Several  teeth,  shewing  the  appearance  of  the 
enamel  when  defective  in  quantity,  the  sur- 
face of  the  teeth  being  covered  with  small 
indentations. 


PLATE  X. 

ALL  THE  FIGURES  OF  THIS  PLATE  ARE  FROM  INJECTED 
PREPARATIONS. 

Fig.  1.  The  under  jaw  of  a  child  at  the  time  of  birth;  the 
fore  part  has  been  removed,  and  the  membranes 
inclosing  the  teeth  are  seen  to  be  vascular. 

Fig.  2.  The  teeth  have  been  turned  out  of  the  sockets, 
and  the  inner  membranes  are  also  seen  to  be 
vascular. 

Fig.  3.  The  lower  jaw  of  a  foetal  calf,  in  which  the  vas- 
cularity of  both  membranes  is  seen.  The 
membrane  belonging  to  one  tooth  has  been 
turned  down  to  exhibit  the  vascularity  on  the 
inner  side. 

Fig.  4.  Half  of  the  upper  jaw  of  a  boy  about  eight  years 
of  age.  Part  of  the  central  incisor,  the  cuspi- 
datus,  the  first  molaris  and  the  second  molaris, 
(not  yet  completely  formed)  has  been  cut 
away  to  show  the  vascularity  of  the  membrane 
within  the  cavities  of  the  teeth.  The  lateral 
incisor  and  the  bicuspides  are  contained  within 
the  membranes. 

Figs.  5,  6,  7,  8,  and  9,  represent  the  manner  in  which 
permanent  teeth  are  formed. 

Fig.  5.  Half  the  under  jaw  of  a  child  soon  after  birth. 
The  membranes  of  the  teeth  are  seen,  and  over 
the  bristle  the  membranes  of  the  pulps  of  the 
incisores  and  the  cuspidatus  of  the  permanent 


144  PLATE    X. 

set,  which  are  firmly  attached  to  the  membranes 
of  the  temporary  teeth. 

Fig.  6.  Part  of  the  jaw  of  a  child  about  three  years  of 
age.  The  permanent  teeth  are  placed  deep 
in  the  jaw,  and  their  membranes  remain  at- 
tached to  the  gams.  The  vessels  of  the  mem- 
branes are  derived  from  the  gums.  The 
artery  which  passes  through  the  jaws  sends  off 
branches  to  the  pulps  of  the  teeth. 

Fig.  7.  Teeth  which  have  been  removed  from  the  sockets 
to  explain  the  attachments  of  the  permanent  to 
the  temporary  teeth. 

a.  The  pulp  of  the  temporary  teeth  inclosed  within 

its  membrane. 

b.  The  pulp  of  the  permanent  teeth  attached  by  its 

membrane  to  that  of  the  temporary. 

c.  The  temporary  tooth  completely  grown. 

d.  The  permanent  tooth  attached  to  the  gum,  the 

membrane  beins:  elongated  into  a  sort  of 
pedicle. 

Fig.  8.  A  section  of  the  lower  jaw,  showing  the  tempo- 
rary tooth,  with  the  manner  of  the  situation 
and  attachment  of  the  permanent  tooth. 

Fig.  9.  Exhibits  the  manner  in  which  the  pulps  of  the 
permanent  molares  are  produced. 

a.  The  first  permanent  molaris  inclosed  in  its  mem- 

brane. 

b.  A  small  membranous  substance  given  off  from 

the  membrane  of  the  first,  and  which  becomes 
the  pulp  of  the  second  permanent  molaris. 
Fig.  10.  Half  of  a  young  jaw,  showing  the  foramina 
through  which  the  membranes  of  the  perma- 
nent teeth  pass,  to  be  attached  to  the  gums. 
A  bristle  is  placed  in  one,  and  is  seen  going 
into  the  socket  of  the  new  tooth. 


PLATE  XI. 

Fig.  1.  The  progress  of   absorption  in  several   of  the 

temporary  cuspidati. 
Fig.  2.  The  same  circumstance  exemplified  in  several  of 

the  temporary  molares. 
Figs.  3  and  4.  Sections  of  the  lower  jaw  exhibiting  the 

progress  in  the  formation  of  the  permanent 

teeth,  and  the  absorption  of  the  fangs  of  the 

temporary  teeth. 
Fig.  5.  Exemplifies  the  changes  which  take  place  in  the 

teeth  at  different  periods. 

A.  Part  of  the  under  jaw  of  a  child  at  six  years, 

when  the  temporary  teeth  only  are  visible. 

B.  Part  of  the  jaw  of  a  child  about  eight  or  nine 

years  of  age.  The  temporary  incisores  and 
cuspidatus  have  been  removed;  the  permanent 
incisores  and  the  first  permanent  molaris  have 
grown  up. 

C.  In  this  jaw  the  first  temporary  molaris  has  been  re- 

moved, and  is  succeeded  by  the  first  bicuspis ; 
the  cuspidatus  and  the  second  permanent 
molaris  are  appearing. 

D.  Part  of  a  jaw  in  the  adult  state.     The  second 

temporary  molaris  has  been  succeeded  by  the 
second  bicuspis.  The  third  molaris,  or  dens 
sapientiae,  has  made  its  appearance.  In  this 
series  of  jaws,  the  change  of  the  temporary 


J  46  PLATE    XI. 

teeth  for  the  permanent,  and  the  addition  of 
the  permanent  molares  are  clearly  elucidated. 
The  teeth  which  succeed  the  temporary  inci- 
sores  and  cuspidati  are  larger,  and  those  which 
succeed  the  temporary  molares  are  smaller. 
Fig.  6.  The  upper  jaw  of  a  foetus,  in  which  only  one 
incisor  had  formed, 
a.  The  incisor. 

b.  b.  The  cuspidati. 

c.  c.  The  first  molares. 


PLATE  XII. 

EXAMPLES  OF  IRREGULARITY  SOMETIMES  OCCURRING  DURING 
THE  SECOND  DENTITION. 

Those  permanent  teeth  which  are  acquiring  an  irregu- 
lar position,  are  sufficiently  obvious.  Those  marked  a  a, 
are  the  temporary  teeth  which  ought  to  be  extracted. 


PLATE  XIII. 

Fig.  1.     One   central   incisor   turned   in,   being   placed 

when  the  mouth  is  elosed;  behind  the  under 

teeth. 

a  a.     The  temporary  lateral  incisores. 
Fig.  2.     The  same  circumstance  occurring  in  both  the 

central  incisores.     The  lateral  incisores  being 

placed  properly. 

a  a.     The  temporary  cuspidati. 
Fig.  3.     The  central  permanent  incisores  rightly  situa- 
ted, the  lateral  ones  turned  in. 

a  a.     The  temporary  cuspidati. 
Fig.  4.     The  four  permanent  incisores,  having  the  same 

improper  situation. 
Fig.  5.     The  bar  to  be  fixed  on  the  teeth,  in  order  to 

remedy  this  kind  of  irregularity. 
Fig.  6.     Represents  the  bar  as  fixed  in  order  to  bring 

one  of  the  central  incisores  forward. 
Fig.  7.     The   bar  fixed;  with  ligatures  applied  to  the 

four  permanent  incisores,  which  are   to    be 

drawn  forward. 


PLATE   XIV. 

(FROM  CATALAN,   DELABARRE,  ROBERTSON  AND  NATURE.) 

Fig.  1.  An  apparatus  invented  by  M.  Catalan  to  be 
placed  upon  the  lower  teeth,  with  four  in- 
clined planes  fixed  to  it,  and  designed  to  act 
upon  the  four  incisores  of  the  upper  jaw. 

Fig.  2.  The  apparatus  applied  with  a  view  to  exhibit 
the  principle  upon  which  it  acts. 

Fig.  3.  In  this  figure,  copied  from  Delabarre,  an  incisor 
tooth  with  one  of  its  approximal  surfaces  pre- 
senting anteriorly,  is  represented. 

Fig.  4.  A  cap  applied  to  the  deviating  incisor  with  liga- 
tures attached  to  it,  for  the  purpose  of  turning 
the  tooth  in  its  socket  until  the  front  surface 
shall  present  anteriorly.  This  figure  is  also 
copied  from  M.  Delabarre. 

Fig.  5.  The  manner  of  correcting  irregularity  of  the 
teeth  by  means  of  ligatures  and  a  metallic 
grate,  as  proposed  by  M.  Delabarre. 

Fig.  6.  This  figure,  representing  an  apparatus  applied  to 
the  lower  teeth  with  an  inclined  plane  acting 
upon  a  central  incisor,  is  copied  from  Mr. 
Robertson's  Treatise  on  the  Teeth. 

Fig.  7.  The  last  named  apparatus  before  being  applied 
to  the  teeth. 

Fig.  8.  A  gold  case  fitted  to  the  lower  teeth  with  an  in- 
clined plane  to  act  upon  a  deviating  cuspidatus, 
constructed  by  the  editor. 
20 


Fig. 

1. 

Fig. 

2. 

Fig. 

3. 

PLATE   XV. 

CASES  OF  IRREGULARITY  FROM    SUPERNUMERARY  TEETH,  be. 

Supernumerary  teeth  of  the  conical  form. 
Supernumerary  teeth  resembling  bicuspides. 
A   tooth   which   acquired    a  distorted    shape 
during   its   formation,    from   the  resistance 
of  the  temporary  tooth. 
Fig.    4.     A  supernumerary  tooth  placed  between  the 

central  incisores. 
Fig.    5.     A  supernumerary  tooth   growing   above    the 

central  and  the  lateral  incisor. 
Fig.    6.     A  remarkable  case  of  irregularity,  occasioned 
by  the  growth  of  two  supernumerary  teeth. 
Fig.    7.     A  similar  case,  the  supernumerary  resembled 

bicuspides  of  the  lower  jaw. 
Fig.    8.     A  case  of  two  lateral  incisores  on  the  same  side. 

irregularity  at  an  advanced  period. 

Fig.  9.  The  lateral  permanent  incisores  to  be  ex- 
tracted. 

Fig.  10.  The  most  irregular  tooth  must  be  removed, 
when  the  others  will  approximate. 

Fig.  11.  A  cuspidatus  left  projecting  until  a  late  pe- 
riod; this  being  removed,  the  teeth  will 
appear  regular,  as  the  lateral  incisor  and 
the  first  bicuspis  are  close  to  each  other. 

Fig.  12.  An  exfoliation  from  the  upper  jaw,  containing 
the  temporary  molares,  and  (a  a)  the  bi- 
cuspides advancing  in  formation,  b.  The 
socket  for  the  permanent  cuspidatus. 


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PART   II. 


THE    HISTORY    AND    TREATMENT    OF    THE    DISEASES    OF    THE 
TEETH,  THE   GUMS,  AND  THE   ALVEOLAR  PROCESSES, 


THE    OPERATIONS    WHICH    THEY    RESPECTIVELY    REQUIRE: 


TO    WHICH    ARE   ADDED 


OBSERVATIONS   ON   OTHER  DISEASES   OF   THE   MOUTH, 


INTRODUCTION. 


In  the  former  part,  I  endeavoured  to  prove  that  the 
teeth  are  organized  in  a  similar  manner  to  other  bones, 
and  that,  as  possessing  life,  they  are  connected  with,  and 
form  an  integral  part  of,  the  system. 

I  have  now  the  satisfaction  to  find  that  the  same  opinion 
is  entertained  by  almost  all  the  enlightened  members  of 
the  surgical  profession. 

Mr.  Hunter,  who  made  many  experiments,  by  feeding 
animals  with  madder,  in  order  to  ascertain  the  effect  it 
would  produce  in  colouring  the  different  bones  of  the 
body,  having  observed  that  the  teeth  did  not  become 
tinged  so  speedily  as  the  other  bones,  or,  when  tinged, 
that  they  retained  their  colour  longer,  hence  concluded, 
that  "they  are  to  be  considered  as  extraneous  bodies, 
with  respect  to  a  circulation  through  their  substance." 

The  consequence  of  having  formed  this  opinion  was, 
that  he  could  not,  in  any  satisfactory  manner,  assign  a 
cause  for  the  different  diseases  of  the  teeth.  It  must, 
however,  appear  extraordinary  that  Mr.  Hunter,  who 
was  so  accurate  an  observer  of  the  phenomena  of  nature, 
should  have  published  this  opinion,  when  he  immediately 
added,  that  "they   (the    teeth)    have   most   certainly   a 


154  INTRODUCTION. 

Jiving  principle,  by  which  means  they  make  part  of  the 
body,  and  are  capable  of  uniting  with  any  part  of  a  living 
body." 

The  diseases  which  affect  the  mouth,  and  which  are 
commonly  considered  as  cases  on  which  the  surgeon-den- 
tist is  to  be  consulted,  arise  from  affections  of  the  teeth, 
the  gums,  and  the  alveolar  processes. 

The  teeth  are  the  organs  of  mastication ;  they  are 
placed  in  sockets  called  alveoli,  which  are  formed  upon 
and  make  a  part  of  the  jaw  bones,  and  are  there  firmly 
held  by  a  periosteum,  which  lines  the  socket,  and  is  also 
reflected  over  the  fangs  of  the  teeth.  The  alveolar  pro- 
cesses are  covered  with  a  continuation  of  the  gums,  which 
are  firm,  but  very  vascular  substances. 

These  parts  have  such  an  intimate  connection  with  each 
other,  that,  when  diseases  originate  in  one,  the  others  al- 
ways become  more  or  less  affected.  It  is  therefore  abso- 
lutely necessary  that  an  accurate  knowledge  should  be 
had  of  all  the  diseases  of  those  parts  connected  with  the 
teeth;  for,  as  the  loss  of  the  teeth  is  the  ultimate  conse- 
quence of  disease  in  any  of  the  contiguous  parts,  we  can 
only  expect  to  preserve  instruments,  so  important  to  our 
comfort  and  welfare,  by  speedily  applying  such  remedies 
as  will  restore  the  parts  with  which  they  are  connected 
to  healthy  action. 

The  diseases  to  which  the  teeth  are  subject  are  similar 
to  those  which  affect  bones  in  general,  and  in  like  manner 
they  have  their  origin  in  inflammation.*  The  teeth  differ 
only  from  bones  in  not  possessing  sufficient  living  power  to 
effect  the  process  of  exfoliation. 

These  different  kind  of  diseases  affect  various  parts  of 

[*To  this  error,  we  alluded  in  the  first  part  of  the  work,  and  our  reasons  Tor  reject- 
in;;  this  hypothesis,  we  shall  presently  state  at  length.] 


INTRODUCTION.  155 

the  teeth.     A  death  of  any  part  of  the  crown  of  a  tooth 
constitutes  caries. 

The  fangs  are  occasionally  enlarged,  as  in  exostosis. 

The  membrane  contained  within  the  cavity  of  a  tooth 
sometimes  inflames  and  suppurates,  and  the  matter,  being 
discharged  at  the  extremity  of  the  fang,  causes  that  part 
of  the  tooth  to  acquire  an  appearance  of  a  bone  affected 
with  spina  ventosa. 

A  death  of  the  fangs  of  the  teeth  often  takes  place,  and 
presents  a  disease  resembling  that  which  in  bones  is 
called  necrosis. 

Besides  these  diseases,  there  are  changes  produced  by 
a  removal  of  the  enamel  from  the  bone  of  the  tooth,  called 
by  Mr.  Hunter,  decay  by  denudation.  Also  very  disa- 
greeable and  painful  affections  resulting  from  accidents, 
such  as  fractures  or  luxations  of  teeth. 

The  gums  are  subject  to  several  diseases  peculiar  to 
themselves,  and  to  others  which  proceed  from  those  of 
the  teeth,  or  alveolar  processes,  beside  other  affections, 
which  may  be  considered  as  the  index  of  constitutional 
derangement. 

The  alveoli  of  the  teeth  have  also  their  distinct  dis- 
eases, as  well  as  others  in  common  with  the  teeth  and 
gums,  and  are  liable  to  be  affected  by  diseases  of  the  consti- 
tution. 

In  addition  to  these  various  diseased  actions,  there  is 
an  earthy  deposit,  called  tartar,  which,  in  a  greater  or  less 
degree,  accumulates  about  the  teeth  of  most  persons;  this, 
if  suffered  to  increase  to  any  quantity,  causes  a  separation 
of  the  gums  from  the  necks  of  the  teeth,  and  a  consequent 
absorption  of  the  alveolar  processes. 

There  are  also  diseases  requiring  surgical  aid  to  which 
the  antrum  maxillare  is  liable;  and  different  imperfections 
of  the  palate  or  roof  of  the  mouth,  arising  either  from 


156  INTRODUCTION. 

natural  malformation,  or  the  consequence  of  disease. — 
When  these  have  been  considered,  the  mode  of  supplying 
the  loss  of  teeth,  by  means  of  artificial  ones,  will  be  de- 
scribed :  and  the  work  concluded  with  an  account  of  the 
method  of  performing  the  several  operations  which  the 
diseases  of  the  teeth  require. 


PART  SECOND 


CHAPTER    FIRST. 

OF  CARIES. 

Caries,  or,  as  it  is  commonly  called,  decay,  is  the  dis- 
ease with  which  the  teeth  are  most  frequently  affected. 
At  first  it  has  its  origin  in  the  bony  part  of  the  crown  of 
the  tooth,  the  structure  of  which  is  gradually  destroyed, 
and  the  disease  proceeds  until  the  whole  of  the  crown  of 
the  tooth,  both  the  enamel  and  bone,  is  entirely  removed. 
[The  enamel,  though  less  frequently,  is  nevertheless  some- 
times, first  attacked.] 

When  caries  has  made  some  progress  internally,  a  small, 
opaque  spot  appears  upon  the  enamel,  where  it  covers 
that  part  of  the  tooth  which  is  diseased,  and  the  bony  part 
of  the  tooth  situated  underneath  this  spot  will  be  found  of 
a  dark  brown  [black, light  brown  or  white]  colour:  when 
the  decay  has  advanced  so  far  as  to  destroy  the  texture  of 
part  of  the  bone  of  the  tooth,  the  enamel  loses  its  support, 
then  breaks  away,  and  a  cavity  is  discovered  in  the  tooth.* 
Thus  it  is  that  in  the  first  instance,  caries  originates;  and 

*  Plate  XVI.  Fig.  1,  2. 

21 


158  OF    CARIES. 

it  is  by  no  means  uncommon  for  a  person,  in  a  very  short 
space  of  time,  to  discover  cavities  in  several  teeth,  which 
had  been  supposed  perfectly  sound.  In  the  mastication 
of  hard  substances,  pieces  of  the  enamel  are  broken  off, 
on  account  of  the  texture  of  the  bony  part  being  destroyed 
by  the  caries,  which  had  previously  gone  on  internally. 

[The  first  manifestation  of  the  disease,  is  in  some]  in 
the  irregularities  of  the  grinding  surfaces  of  the  molares, 
and  resembles  a  crack  filled  with  a  black  substance,  which 
at  length  breaks  into  a  cavity  in  the  centre  of  the  tooth ; 
in  others,  it  commences  in  the  side  of  the  tooth  next  the 
cheek;  and  sometimes  at  the  neck  of  the  tooth,  the  de- 
cay extending  into  the  body  of  the  tooth  underneath  the 
enamel. 

The  decay  very  often  commences  on  those  sides  of  the 
teeth  which  are  placed  in  opposition  to  each  other;  this 
is  the  worst  possible  situation  for  the  disease,  because  it 
often  makes  considerable  progress  without  being  disco- 
vered, and  is  much  less  conveniently  placed  for  the  per- 
formance of  an  operation  to  arrest  its  progress. 

In  the  incisores,  the  caries  most  commonly  begins  at  the 
sides,  between  the  teeth;  in  some,  it  appears  near  the 
neck,  the  cavity  extending  across  the  tooth  and  the  dis- 
ease proceeds  until  the  tooth  is  nearly  divided  in  two ;  in 
this  case,  wThilst  biting  something  hard,  the  lower  part 
of  the  tooth  usually  breaks  off,  leaving  the  fang  in  the 
socket,  and  a  small  portion  of  the  body  of  the  tooth. 

The  molares  are  more  subject  to  this  disease  than  any 
of  the  other  teeth:  the  incisores  of  the  upper  jawr  are 
very  frequently  affected  by  it,  whilst  the  incisores  of  the 
lower  jaw  very  seldom  become  decayed. 

When  a  decayed  tooth  is  examined,  the  carious  part 
appears  to  be  disposed  in  strata,  the  external  is  the  most 
decayed,  is  black,  and  so  soft  that  it  may  be  easily  picked 


OF    CARIES.  159 

away.*  The  next  stratum  will  be  found  of  a  harder 
texture,  and  not  so  black  in  colour,  and  as  the  substance 
of  the  tooth  is  less  decayed  it  becomes  more  dense,  until 
we  arrive  at  the  sound  part.  Whenever  a  decay  has 
taken  place  in  a  tooth,  and  the  enamel,  by  becoming 
opaque,  begins  to  exhibit  the  appearances  of  this  disease 
as  having  gone  on  underneath,  if  the  tooth  be  sawn 
through,  a  brown  mark  will  be  found  extending  into  the 
natural  cavity  of  the  tooth :  it  is  in  this  direction  the  de- 
cay always  proceeds,  and,  when  the  cavity  is  exposed, 
the  membrane  which  lines  it,  and  upon  which  the  nerve 
and  the  blood-vessels  ramify,  most  commonly  becomes 
inflamed,  and  causes  pain. 

During  the  progress  of  caries  in  a  tooth,  it  is  the  inter- 
nal part  of  the  crown  which  is  the  soonest  removed, 
causing  the  tooth  to  appear  as  if  the  inside  had  been 
scooped  out.  The  enamel,  being  much  harder  than  the 
bone,  remains,  and  only  breaks  away  as  it  loses  its  sup- 
port, from  the  bony  part  becoming  dissolved  and  re- 
moved, f 

The  progress  of  caries  seems  to  be  retarded  when  it 
has  destroyed  the  whole  crown  of  a  tooth ;  for  although 
the  decay  may  have  gone  on  in  the  body  of  the  tooth 
with  great  rapidity,  yet  the  fangs  will  often  remain  for 
many  years  with  scarcely  any  alteration,  and  they  often 
continue  for  a  considerable  length  of  time  firmly  attached 
to  the  socket,  without  occasioning  any  inconvenience. 
Persons  rarely  experience  the  tooth-ache,  properly  so 
called,  from  stumps;  for,  when  the  caries  has  destroyed 
the  whole  of  the  body  of  the  tooth,  the  membrane  which 

[*  The  consistence  of  the  carious  part  of  a  tooth  is  exceedingly  variable, — depend- 
ing upon  the  density  of  the  organ.  In  some  teeth,  it  is  almost  as  hard  as  the  tooth 
itself  throughout  every  part  of  it;  in  others,  it  is  very  soft,  and  the  colour  is  gene- 
rally dark  in  proportion  to  the  density  of  the  affected  organ.] 

f  Plate  XVI.  Fig.  4,  5. 


160  PROXIMATE    CAUSE    OF    CARIES. 

lines  the  cavity  is  also  removed,  and  the  blood-vessels 
and  nerves,  which  pass  through  the  canal  in  the  fangs, 
generally  likewise  perish;  on  which  account,  whenever 
pain  proceeds  from  decayed  stumps,  it  usually  is  the  con- 
sequence of  inflammation  taking  place  in  the  sockets, 
whereby  the  attachment  of  the  periosteum  is  destroyed, 
and  the  stump  becomes  an  extraneous  body,  causing 
great  inflammation  in  the  socket  and  the  gums,  which 
often  terminates  in  suppuration. 

It  very  frequently  happens,  when  a  tooth  has  become 
so  decayed  as  to  leave  only  the  stumps,  that  nature,  as  if 
conscious  they  were  no  longer  useful,  makes  an  effort  to 
thrust  them  out;  the  socket  gradually  closes  at  the  bot- 
tom, and  thus  the  stumps  are  protruded,  until  they  only 
adhere  to  the  gum,  thus  they  become  loose,  and  occasion 
soreness  and  slight  inflammation.  The  attachment  being 
very  weak,  they  are  with  great  ease  taken  away.* 

[PROXIMATE   CAUSE   OF  CARIES.] 

The  cause  of  caries  has  not  been  satisfactorily  ex- 
plained, from  the  structure  of  the  teeth  not  having  been 
duly  considered.  Mr.  Hunter  says,  "It  does  not  arise 
from  external  injury,  or  from  menstrua,  which  have  a 
power  of  dissolving  part  of  a  tooth;  but  we  may  reason- 
ably suppose  that  it  is  a  disease  arising  originally  in  the 
tooth  itself."  It  is  surprising  that,  although  Mr.  Hunter 
went  thus  far,  he  gave  no  correct  idea  of  the  manner  in 
which  the  disease  can  alone  originate. 

The  proximate  cause  of  caries  appears  to  be  an  inflam- 
mation in  the  bone  of  the  crown  of  the  tooth,  which,  on 
account  of  its  peculiar  structure,  terminates  in  mortifica- 
tion. 

*  Plate  XVI.  Fig.  6,  a. 


PROXIMATE    CAUSE    OF    CARIES.  161 

[The  author's  opinion  with  regard  to  the  cause  and 
nature  of  dental  caries  is,  as  the  editor  has  shown  in 
another  place,  evidently  incorrect.*  If  it  were  the  result 
of  inflammation,  as  he  asserts,  none  but  living  teeth 
would  be  attacked  by  it,  but  so  far  from  this  being  the 
fact,  it  is  well  known  that  teeth  after  having  been  de- 
prived of  their  vitality  are  as  liable  to  be  affected  with  it 
as  the  living  organs.  Artificial  teeth  too,  of  bone  or 
ivory,  decay  as  readily  as  the  natural  ones. 

Caries  of  the  teeth  is  the  result  of  the  action  of  chemi- 
cal agents,  and  not  that  of  any  operation  of  the  animal 
economy,  and  it  consists  simply  in  the  decomposition  of 
the  calcareous  molecules  of  the  organs.  The  fluids  of 
the  mouth,  especially  the  mucous,  when  in  a  vitiated 
condition,  contain  an  acid,  namely,  the  septic  (nitrous,) 
which  has  a  strong  affinity  for  the  earthy  ingredients  of 
these  organs,  and  it  is  by  the  action  of  the  former  upon 
the  latter,  that  the  affection  is  produced.  Inflammation 
may  influence  the  progress  and  perhaps  the  appearance 
of  the  diseased  part,  but  it  cannot  of  itself  produce  it. 

If  inflammation  were  the  cause  of  caries,  the  opera- 
tions of  filing  and  plugging,  would  tend  rather  to  increase 
than  arrest  its  progress,  inasmuch  as  they  augment,  for  a 
time  at  least,  the  susceptibility  of  the  organs  to  impres- 
sions from  heat  and  cold,  and  as  a  consequence  to  inflam- 
mation. They  do  not,  however,  when  properly  per- 
formed, give  rise  to  the  disease  in  question.  On  the 
contrary,  they  completely  arrest  it. 

A  series  of  experiments  were  instituted  about  three 
years  since,  by  Amos  Westcott,  M.  D.  of  Syracuse,  N.  Y. 
who  is  well  known  to  the  profession  as  an  accomplished 
writer  and  able  practitioner,  for  the  purpose  of  ascertain- 

*  Vide,  Principles  and  Practice  of  Dental  Surgery ;  also,  Characteristics  of  the 
Teeth,  &c.  fee.  by  the  Editor. 


162  PROXIMATE    CAUSE    OF    CARIES. 

ing  the  effect  certain  aliments  produced  upon  the  teeth, 
after  having  underwent  chemical  decomposition,  and  the 
result  proves  conclusively,  that  caries  of  the  teeth  is  pro- 
duced by  the  action  of  external  corrosive  agents.  For  a 
detailed  account  of  these  experiments,  the  reader  is  re- 
ferred to  a  Dissertation  delivered  by  Dr.  W.  before  the 
fourth  annual  meeting  of  the  American  Society  of  Dental 
Surgeons,  and  published  in  the  3d  vol.  Amer.  Jour. 
Dental  Science. 

The  term  mortification,  or  gangrene,  as  used  by  a  later 
writer,  if  at  all  applicable  to  any  morbid  condition  of  the 
teeth,  would  be  more  so  to  that  of  necrosis,  than  the 
affection  under  consideration.  But  to  neither  of  which, 
according  to  its  usual  signification,  can  it  with  any  degree 
of  propriety  be  applied,  it  being  a  term  used  to  signify 
the  death  of  a  soft,  not  that  of  a  solid  tissue.  Nor  does 
caries  convey  a  correct  idea  of  the  true  nature  of  the 
affection,  yet  because  of  its  almost  universal  adoption,  it 
may,  perhaps,  be  as  well  to  continue  it.] 

The  membrane  which  is  contained  within  the  cavity  of 
a  tooth  is  very  vascular,  and  possesses  a  high  degree  of 
nervous  sensibility:  an  inflammation  of  this  membrane  is 
liable  to  be  occasioned  by  any  excitement  which  produces 
irregular  action;  and  as  the  bone  of  the  tooth  is  very 
dense,  and  possesses  little  living  power,  a  death  of  some 
part  of  it  may  speedily  follow  an  inflammation  of  the  ves- 
sels of  the  membrane  which  are  contained  within  the 
cavity.* 

*  Some  time  ago,  I  was  applied  to  by  a  gentleman,  who  complained  of  an  acute 
pain  arising  from  one  of  the  molares  of  the  under  jaw:  as  I  could  discover  no  appear- 
ance of  caries  in  it,  I  advised  the  loss  of  blood  from  the  gums,  with  a  view  to  remove 
the  inflammation  in  the  socket,  or  other  parts  connected  with  the  tooth.  This  treat- 
ment was  by  no  means  effectual,  for  the  pain  continued  with  scarcely  any  intermis- 
sion: the  gentleman  therefore  determined  to  have  the  tooth  extracted.  In  attempting 
this  operation,  the  tooth  broke  off  at  the  neck,  and  completely  exposed  the  internal 
cavity.     Fortunately,  this  accident  proved  to  be  satisfactory,  as  it  afforded  an  oppor- 


PROXIMATE    CAUSE    OF    CARIES.  163 

If  a  sound  tooth,  that  has  been  recently  extracted,  be 
broken,  the  membrane  will  be  found  to  be  firmly  attached 
to  the  bone  of  the  tooth,  forming  the  inner  cavity.  But 
when  this  membrane  becomes  inflamed,  it  separates  from 
the  bone,  and  the  death  of  the  tooth  is  the  consequence. 

That  this  is  the  proximate  cause  of  caries,  appears  to 
be  highly  probable,  by  remarking  that  a  caries  of  other 
bones  is  caused  by  a  separation  of  those  membranes  which 
cover  them,  and  which  are  attached  to  them.  Thus  a 
separation  of  the  periosteum  will  cause  a  death  of  part  of 
the  tibia,  or  that  of  the  pericranium,  a  caries  of  some  part 
of  the  bones  of  the  head. 

This  opinion  is  also  confirmed  by  comparing  the 
symptoms  which  accompany  inflammation  in  a  bone  with 
those  which  are  occasionally  felt  by  persons  in  their  teeth, 
previously  to  any  appearance  of  caries. 

During  the  inflammation  of  a  bone,  there  is  an  obtuse, 
rather  than  an  acute  pain;  the  parts  which  surround  or 
cover  it  feel  sore,  and  cannot  bear  pressure;  and,  when 
there  is  the  opportunity  of  making  the  comparison,  an 
inflamed  bone  is  found  to  have  a  darker  appearance  than 
a  healthy  one. 

Very  similar  to  these  are  the  symptoms  which  are  ob- 
served by  every  one  when  their  teeth  have  been  affected 
by  what  is  commonly  termed  a  cold.  At  this  time  a  dull, 
uneasy  pain  is  felt  extending  along  the  jaw,  the  teeth  are 
tender,  and  cannot  be  pressed  together  with  the  ordinary 
degree  of  force;  and  it  may  almost  always  be  observed, 

tunity  of  ascertaining  the  cause  of  the  pain.  The  membrane  lining  the  cavity  of  the 
tooth  had  become  so  highly  inflamed,  that  it  had  proceeded  to  suppuration,  and  the 
cavity  of  the  tooth  was  filled  with  pus.  Immediately  after  the  operation,  the  gentle- 
man was  perfectly  relieved,  and  had  no  return  of  pain.  In  a  similar  case,  instead  of 
extracting  the  tooth,  I  should  recommend  the  drilling  a  hole,  at  the  neck  of  the  tooth, 
into  the  cavity,  in  order  to  make  an  opening  by  which  the  matter  might  escape. 
[But  this  operation,  while  it  will  generally  afford  relief  from  pain,  seldom  effects  a 
radical  cure.     Therefore,  it  is  better  in  most  instances  to  remove  it  at  once.] 


164  PROXIMATE    CAUSE    OF    CARIES. 

that  the  teeth  thus  affected  have  a  darker  appearance  than 
those  which  are  perfectly  free  from  pain. 

When  these  inflammatory  symptoms  subside,  the  pain 
in  the  teeth  goes  off;  but  as  inflammation  may  have  caused 
a  death  of  some  part  of  one  or  more  teeth,  the  decomposi- 
tion of  the  internal  part  of  the  tooth  goes  on,  until  the 
enamel  is  broken  away,  and  a  caries  is  discovered. 

I  could  mention  many  cases  in  corroboration  of  this 
statement,  and  produce  several  examples  of  teeth  with 
the  decay  extending  through  the  internal  part;  whilst  the 
enamel  remained  perfectly  sound. 

In  Plate  XVI.  Fig.  4  a,  is  the  representation  of  a  tooth 
which  I  extracted  for  a  lady,  who  complained  of  having 
suffered  great  pain  from  it  for  a  length  of  time;  the  tooth 
appeared  to  be  perfectly  sound,  but,  on  sawing  it  asunder, 
a  considerable  caries  was  discovered  in  the  centre. 

Fig.  5  a  represents  the  perfect  enamel  of  a  tooth  that 
separated  from  the  bony  part,  which,  by  caries,  had  be- 
come quite  soft  and  black. 

Fig.  3  a  shows  the  dark  line  which  may  be  seen  pass- 
ing through  the  bone  of  a  tooth  from  the  external  part  to 
the  cavity,  in  the  centre,  as  described  in  page  159. 

[Inflammation  of  the  lining  membrane  of  a  tooth  often 
terminates  in  suppuration  and  the  death  of  the  crown  and 
inner  walls  of  the  root,  or  roots,  if  it  have  more  than  one, 
of  the  organ — gives  rise,  in  the  majority  of  cases,  to  the 
formation  of  alveolar  abscess,  but  the  only  indication  of 
caries  resulting  therefrom,  is  the  softening  of  the  inner 
wralls  of  the  tooth,  caused  by  the  chemical  action  of  the 
matter  therein  contained.  But  examples  of  this  sort,  are 
comparatively  rare,  and  between  the  pulp  cavity  and  ex- 
ternal surface  of  the  bone  of  a  tooth,  within  its  substance 
caries  never  commences. 

The  symptoms  mentioned  by  the  author,  as  being  an 


PROXIMATE    CAUSE    OF    CARIES.  165 

accompaniment  of  inflammation,  are  rarely  present  during 
the  progress  of  caries,  or  not  until  the  lining  membrane 
has  become  exposed.  The  disease,  until  this  time,  is 
seldom  attended  with  pain,  and  it  oftentimes  happens,  that 
tooth  after  tooth,  until  not  a  sound  one  remains,  is  de- 
stroyed by  it,  without  giving  rise  to  any  unpleasant  symp- 
toms whatever.  Again,  the  membranes  of  the  teeth  often 
become  inflamed,  causing  pain  and  soreness  in  the  teeth 
for  weeks  and  even  months,  without  being  accompanied 
or  followed  by  caries. 

The  decomposition  of  the  internal  part  of  a  tooth,  as 
spoken  of  by  Mr.  Fox,  is  caused,  not  by  inflammation, 
but  by  the  acrimonious  qualities  of  the  fluids  which  ac- 
cumulate in  the  pulp  cavity  after  the  destruction  of  the 
lining  membrane,  and  not  only  do  they  break  down  the 
solid  basis  of  the  parts  of  the  organ  with  which  they  are 
in  immediate  contact,  but  they  give  to  the  whole  of  the 
crown  of  the  tooth,  a  dark  brown,  muddy  or  purple  ap- 
pearance. If  the  tooth  be  permitted  to  remain  in  the 
mouth,  and  no  outlet  made  for  the  escape  of  the  matter, 
nor  means  used  to  prevent  its  re-accumulation,  the  de- 
struction of  its  interior  walls  goes  on,  until  ultimately,  in 
biting  some  hard  substance,  the  crown  is  broken  in,  when 
the  ravages  of  the  disease  becomes  manifest. 

Caries  almost  always  commences  on  the  exterior  surface 
of  the  tooth,  beneath  the  enamel,  and  at  points  where  this 
outer  casing  has  sustained  some  injury,  or  is  imperfect,  as 
for  example,  within  the  indentations  on  the  grinding  faces 
of  the  molares  and  bicuspides  or  the  approximal  sides  of 
the  organs,  and  proceeds  interiorly  toward  the  centre.] 


22 


166  PREDISPOSING    CAUSE    OF    CARIES. 

[PREDISPOSING    CAUSE   OF    CARIES.] 

The  chief  predisposition  to  this  disease  consists  in  a 
defective  formation  of  either  the  enamel  or  the  bony  part 
of  the  teeth. 

The  teeth  of  many  persons  are  formed  with  a  less 
quantity  of  earthy  matter  than  of  animal  substance,  on 
which  account  they  do  not  acquire  such  a  density  as  is 
necessary  to  make  them  durable,  and  resist  those  various 
causes  of  decay  to  which  the  teeth  are  constantly  ex- 
posed. Teeth  thus  formed  are  at  first  very  white,  and 
have  a  certain  transparency;  but  they  soon  begin  to 
decay,  and  frequently,  in  a  very  few  years,  the  disease 
extends  through  the  greater  part  of  them. 

Sometimes  the  enamel  does  not  acquire  a  proper 
degree  of  hardness,  its  attraction  of  cohesion  being  defec- 
tive, in  which  case  it  has  a  dead  yellowish  tinge,  and  is  of 
a  chalky  consistence. 

When  either  of  the  above  states  of  formation  of  the 
teeth  occur,  they  very  soon  fall  into  a  state  of  disease;  be- 
cause the  enamel  is  not  sufficiently  dense  to  resist  the 
force  applied  to  the  teeth,  in  the  mastication  of  hard  sub- 
stances, without  being  broken;  and  the  bone  is  of  too 
soft  a  texture  to  continue  long  without  being  affected  by 
some  cause  of  inflammation.  [The  author  should  have 
said  to  the  action  of  the  chemical  agents,  to  which  all  teeth 
are  more  or  less  constantly  exposed.] 

This  original  defect  in  the  structure  of  the  teeth  must 
depend  upon  a  want  of  healthy  action  in  the  pulps,  during 
the  time  of  the  formation  of  the  teeth.  It  is  impossible 
to  conjecture  what  can  be  the  cause  of  this  imperfection, 
but  it  is  very  singular,  and  also  very  certain,  that  the  same 
kind  of  structure  may  be  observed  in  the  teeth  of  many 
individuals  in  the  same  family,  who,  in  all  other  respects, 
are  very  healthy. 


PREDISPOSING    CAUSE    OF    CARIES.  167 

That  the  teeth  acquire  this  disposition  to  decay  from 
some  want  of  healthy  action,  during  their  formation,  seems 
to  be  proved  by  the  common  observation,  that  they  be- 
come decayed  in  pairs;  that  is,  those  teeth  which  are 
formed  at  the  same  time  being  in  a  similar  state  of  imper- 
fection, have  not  the  power  to  resist  the  causes  of  disease, 
and,  therefore,  nearly  about  the  same  period,  they  exhibit 
signs  of  decay,  while  those  teeth  which  have  been  formed 
at  another  time,  when  a  more  healthy  action  has  existed, 
have  remained  perfectly  sound  to  the  end  of  life. 

Decay  of  the  teeth  is  often  the  consequence  of  certain 
states  of  the  constitution,  in  which  the  functions  of  the 
body  are  performed  irregularly,  inducing  various  dys- 
peptic symptoms.  [Just  in  proportion,  as  any  functional 
disturbance  of  the  body  deteriorates  the  healthy  qualities 
of  the  fluids  of  the  mouth,  does  it  contribute  to  the  decay 
of  the  teeth.] 

In  these  cases,  the  caries  affects  many  teeth  at  the 
same  time,  and  often  proceeds  so  quickly  as,  in  a  short 
period,  to  destroy  the  crowns  of  the  teeth,  leaving  only 
the  fangs.  [This  is  more  especially  the  case  when  all  the 
teeth  are  equally  susceptible  to  the  action  of  those  causes 
upon  the  presence  of  which,  the  decay  of  the  teeth  is 
dependent.] 

It  is  remarkable  that  the  caries,  arising  from  these  con- 
stitutional affections,  has  often  a  whitish  appearance,  and 
the  bone  of  the  tooth  is  then  much  softer  than  when  it 
proceeds  from  simple  inflammation.  [The  density  of  the 
tooth  has  more  to  do  with  the  colour  of  the  caries  than 
any  constitutional  causes  which  may  be  concerned  in  its 
production.  Generally,  in  proportion  to  the  softness  of  a 
tooth  is  the  colour  of  the  caries  light,  and  to  its  density  is 
it  dark.] 

I  have  also  often  had  occasion  to  observe  that  great; 


168  PREDISPOSING    CAUSE    OF    CARIES. 

changes  take  place  in  the  economy  of  the  teeth,  in  conse- 
quence of  continued  fever:  however  sound  the  teeth  of 
such  persons  may  have  been,  previously  to  the  disease, 
they  have  shortly  afterwards  discovered  marks  of  caries, 
by  which,  in  a  few  years,  many  of  the  teeth  have  been 
injured  or  destroyed.  [This  however  is  to  be  accounted 
for  by  the  fact,  that  such  diseases  always  vitiate  the  secre- 
tions of  the  mouth,  especially  the  mucous,  and  impart  to 
them  a  corrosive  quality,  which  they  do  not,  when  in 
health,  possess.  At  such  times  too,  little  or  no  attention  is 
paid  to  keeping  the  teeth  clean,  and  in  consequence  they 
become  coated  with  clammy  acidulated  mucus,  and  which 
by  its  long  contact,  causes  a  more  general  and  rapid  decay.] 

Caries  has  been  very  commonly  attributed  to  the  use 
of  certain  articles  of  diet,  and  animal  food  has  been  sup- 
posed very  much  to  contribute  to  this  disease.  In  sup- 
port of  this  opinion,  it  is  observed  that  persons  in  the 
country,  who  live  on  plain  fare,  and  those  of  Indian  na- 
tions, who  live  on  vegetable  food,  have  their  teeth  per- 
fectly sound  and  free  from  disease.  That  these  persons 
are  very  often  found  to  possess  perfect  sets  of  teeth,  is  in- 
controvertible; but  it  is  also  to  be  observed  that,  amongst 
the  same  classes  of  mankind,  there  are  great  numbers 
whose  teeth  are  very  much  diseased. 

But  why  should  animal  food,  more  than  any  other  kind, 
produce  disease  in  the  teeth?  In  a  chemical  way,  it  can- 
not act  upon  them;  and,  if  in  itself  it  had  any  injurious 
action  upon  the  teeth,  then  all  carnivorous  animals,  whose 
teeth  are  of  the  same  structure  as  the  human,  ought 
equally  to  be  liable  to  caries. 

The  various  articles  of  our  food  can  only  produce  a 
diseased  action  in  the  teeth,  in  consequence  of  their  being 
taken  at  a  temperature  either  much  above  or  below  the 
natural  heat  of  the  bod  v. 


PREDISPOSING    CAUSE    OF    CARIES.  169 

The  experience  of  every  one  teaches,  by  the  effects, 
that  extremes  of  heat  or  cold  are  injurious,  because  the 
sudden  application  of  either,  generally  occasions  a  very 
unpleasant  sensation  in  the  teeth;  this  painful  feeling 
arises  from  irregularity  being  produced  in  the  circulation 
within  the  cavities  of  the  teeth,  and  also  the  application 
of  an  unnatural  degree  of  heat  affecting  the  nerves  of  the 
teeth,  and  producing  that  painful  sensation  consequent  on 
such  application. 

The  reason  therefore  why  persons,  who  live  in  a  less 
luxurious  state,  have  their  teeth  less  liable  to  caries  is, 
that,  their  food  being  all  of  a  moderate  temperature,  they 
are  not  injured  by  that  frequent  stimulus  which  is  pro- 
duced by  the  use  of  very  hot  or  cold  substances.  This 
statement  seems  to  be  confirmed  by  the  observations  I 
have  been  enabled  to  make  upon  the  teeth  of  persons 
inhabiting  different  situations. 

As  a  general  rule,  I  think  it  may  be  asserted  that  the 
inhabitants  of  warm  inland  countries  have  teeth  free  from 
disease,  and  that  those  who  dwell  in  colder  regions,  and 
also  in  seaports  and  large  towns,  have  bad  sets  of  teeth. 
For,  in  all  warm  countries,  the  refreshment  which  always 
accompanies  the  application  of  whatever  is  cool,  induces 
persons  to  make  use  of  their  culinary  preparations  at  a 
moderate  degree  of  heat,  and  their  drink  consists  of  such 
articles  as  are  proper  to  allay  thirst,  and  produce  but  little 
stimulus. 

In  cold  countries,  on  the  contrary,  where  the  applica- 
tion of  heat  is  congenial  to  the  feelings,  the  food  is  taken 
very  hot;  also  in  these  regions,  and  likewise  in  seaports 
and  places  of  great  commercial  intercourse,  strong  spiritu- 
ous and  fermented  liquors  are  very  constantly  made  use 
of,  which,  in  addition  to  the  injury  arising  from  the  use 
of  the  food  at  a  high  degree  of  temperature,  keep  the 


170  PREDISPOSING    CAUSE    OF    CARIES. 

mouth  in  constant  heat,  and  produce  all  the  injurious 
effects  which  arise  from  the  accidental  occurrence  of 
fever. 

[Neither  the  variations  of  temperature,  nor  food,  nor 
drinks,  has  any  agency  in  the  production  of  caries,  for  if  it 
had,  teeth  whose  susceptibility  to  the  action  of  heat  and 
cold,  as  has  been  before  stated,  has  been  increased  by  dental 
operations,  would  be  more  liable  to  decay  than  others. 
But  this  is  not  the  fact,  and  hence  the  inference  is  incor- 
rect. The  supposition  too,  that  particular  sorts  of  diet 
exert  a  more  deleterious  influence  upon  the  teeth  than 
others,  is  equally  gratuitous.  They  can  do  this  only  as 
they  prejudicially  affect  the  health  of  the  body  and  impair 
the  healthy  qualities  of  its  fluids.  The  same  may  also  be 
said  with  regard  to  climate.  As  a  general  rule,  those 
who  have  good  innate  constitutions  and  have  enjoyed 
good  health  during  infancy  and  childhood  have  well- 
formed  and  regularly  arranged  teeth — teeth  not  easily 
acted  upon  by  the  causes  that  produce  caries;  and  as  their 
constitutions  are  otherwise,  will  their  teeth  be  susceptible 
to  the  action  of  such  cause.] 

The  destruction  of  a  tooth,  which  has  become  carious 
in  the  manner  above  described,  is  not  the  extent  of  the 
mischief,  for  the  disease  is  generally  communicated  to 
those  teeth  which  are  in  contact  with  the  decayed  part. 
Cases  occasionally  occur  which  appear  to  militate  against 
this  opinion;  as,  for  instance,  a  tooth  may  become  de- 
cayed, and  be  entirely  broken  away  without  causing  any 
disease  in  the  neighbouring  ones.  Such  examples,  how- 
ever, are  rare;  and  it  may  be  asserted,  as  a  general  rule, 
that  caries  in  one  tooth  will  produce  disease  in  that  which 
is  contiguous. 

When  the  caries  is  communicated  by  contact,  it  proba- 
bly arises  from  the  action  of  some  acrimonious  discharge 


PREDISPOSING    CAUSE    OF    CARIES.  171 

from  the  decaying  tooth,  which,  in  the  first  place,  oc- 
casions a  decomposition  of  the  enamel,  and  afterwards 
the  destruction  of  the  tooth.  But  there  is  this  peculiar 
difference,  that,  in  the  one,  the  decay  proceeds  from  the 
interior  to  the  exterior  part;  whilst,  in  the  other,  it  com- 
mences on  the  surface,  and  extends  towards  the  cavity. 
[If  this  cause  is  capable  of  producing  it  in  the  one  case  it 
is  fair  to  conclude  it  is  in  the  other.] 

Caries  is  also  very  frequently  the  consequence  of  the 
teeth  being  crowded  so  much  together,  as  to  cause  them 
to  be  pressed  too  closely  against  each  other.  This  is  the 
most  common  cause  of  the  decay  of  the  incisores  in  the 
upper  jaw,  on  which  account,  in  the  earlier  part  of  life, 
means  should  be  made  use  of  to  give  more  room,  which 
would  permit  the  teeth  to  separate,  and  press  with  less 
force  on  each  other.*  If  the  person  be  more  advanced 
in  years,  then  a  small  space  should  be  made  by  passing  a 
thin  file  between  all  the  front  teeth. 

[Filing  teeth  to  gain  room  for  the  purpose  of  correcting 
a  slight  irregularity  is  a  practice  which  has  been  produc- 
tive of  incalculable  injury.  The  editor  has  frequently  in 
other  places,  expressed  his  disapproval  of  it,  and  he  is 
happy  to  believe,  that,  at  present,  it  is  seldom  resorted  to 
for  this  purpose.  For  the  removal  of  caries  on  the  ap- 
proximal  surfaces  of  the  teeth,  the  file,  in  the  hands  of  a 
skilful  practitioner,  is  one  of  the  most  valuable  resources 
of  the  dental  art,  but  in  the  hands  of  an  ignorant  and 
inexperienced  operator,  it  is  an  unsafe  and  dangerous 
instrument. 

When  the  file  is  employed  for  the  above  mentioned 
purpose,  the  filed  surfaces  soon  come  together,  and  give 
lodgment  to  the  mucous  secretions  of  the  mouth  and  other 
extraneous  matter,  which  by  being  retained  there  soon  be- 

*  Vide  Natural  History  of  the  Teeth,  page  62. 


172  PREVENTION    OF    CARIES. 

come  vitiated,  and  act  chemically  upon  the  rough  denuded 
sides  of  the  teeth.  Thousands  of  teeth  have  in  this  way 
been  sacrificed.  I  will  not  however,  in  this  place,  dwell 
longer  upon  this  subject,  as  I  shall  have  occasion  hereafter 
to  advert  to  it  more  at  length.] 

To  these  various  causes  of  decay  of  the  teeth,  may  be 
added,  want  of  cleanliness  in  the  mouth,  and  a  diseased 
state  of  the  gums.  When  the  teeth  are  not  regularly 
cleansed  from  the  tartar  which  constantly  gathers  about 
them,  and  also  particles  of  food  which  may  lodge  between 
them,  a  putrefactive  fermentation  takes  place,  which  (not 
to  speak  of  the  offensive  fetor  it  produces)  always  injures 
the  gums,  and  disposes  the  teeth  to  fall  into  a  state  of 
decay. 

[PREVENTION    OF    CARIES.] 

The  great  distress  which  usually  accompanies,  and  the 
inconvenience  which  always  follows,  the  loss  of  the  teeth, 
makes  the  discovery  of  some  mode  of  prevention  of  caries 
very  desirable. 

This  delightful  secret,  although  it  is  pretended  to  in  the 
advertisements  of  every  quack,  we  can  only  expect  to 
acquire  when  the  philosopher's  stone  and  the  grand 
panacea  have  been  obtained.  It  is  not  in  our  power  to 
alter  the  laws  of  nature,  or  change  the  natural  constitution 
of  man;  we  can  only  obviate  evils  by  attending  to  the 
causes  which  produce  them,  and  it  is  in  this  manner  we 
can,  in  a  very  great  measure,  preserve  the  teeth  from 
disease. 

The  principle  means  of  preserving  the  teeth  from 
decay  consist  in  paying  such  a  degree  of  attention  to  them 
in  early  life,  during  the  period  of  the  second  dentition,  as 
to  allow  the  permanent  teeth  to  acquire  a  proper  regular- 
ity, without  pressing  too  much  upon  each  other;  and,  at 


PREVENTION    OF    CARIES.  ]  73 

the  same  time,  if  the  temporary  teeth  should  become 
decayed,  and  be  in  contact  with  any  of  the  new  teeth, 
they  should  be  removed.  [The  better  practice,  when 
practicable,  is  to  remove  the  decayed  surfaces  of  the 
temporary  teeth  with  a  file.] 

When  these  circumstances  have  been  observed,  young 
persons  should  be  urged  to  keep  their  teeth  very  clean, 
and  the  daily  use  of  a  tooth  brush,  with  water  only,  will 
in  most  cases  be  quite  sufficient.  In  addition  to  cleanli- 
ness, the  habitual  use  of  all  kinds  of  food  at  a  moderate 
temperature  will  almost  certainly  prevent  any  disease 
from  taking  place,  unless  there  be  any  radical  defect  in 
the  teeth  themselves. 

[In  addition  to  the  use  of  the  brush,  great  advantage 
may  be  derived  from  the  employment  of  waxed  floss  silk, 
as  recommended  by  Dr.  L.  S.  Parmly.  This  is  used 
by  passing  it  between  the  teeth  or  around  a  single  tooth 
at  a  time  and  drawing  the  ends  backwards  and  forwards 
some  ten  or  a  dozen  times.  In  this  way  the  impurities 
that  cannot  be  reached  with  a  brush,  are  removed  from 
between  the  teeth,  and  which,  when  permitted  to  re- 
main, cause  their  decay.  If  it  were  possible  to  keep  the 
teeth  thoroughly  and  constantly  clean,  they  would  never 
decay. 

With  regard  to  the  influence  the  temperature  of  food 
exercises  on  the  teeth,  I  have  before  alluded;  it  is  not 
necessary  therefore,  to  say  more  upon  that  subject.] 

If,  in  persons  more  advanced  in  years,  any  of  the  teeth 
should  have  become  decayed,  and  be  in  contact  with 
sound  ones,  and  they  are  not  sufficiently  injured  to  make 
it  necessary  that  they  should  be  extracted,  so  much  of 
them  should  be  filed  away,  as  to  separate  them  from 
those  teeth  which  are  sound :  this  will  prevent  the  decay 
from  being  communicated. 
23 


174  PREVENTION    OF    CARIES. 

If  the  teeth  have  become  so  much  decayed  as  to  leave 
only  stumps,  then  they  should  be  extracted,  because  they 
are  not  only  liable  to  cause  the  other  teeth  to  become 
diseased,  but  they  often  produce  gum-boils  and  other  dis- 
eases of  the  sockets.  [They  also  exert  a  deleterious  in- 
fluence on  the  general  health,  giving  rise  not  unfrequently 
to  dyspepsia,  neuralgia  of  the  face  and  a  multitude  of  other 
diseases,  so  that  the  importance  of  their  removal  cannot 
be  too  strongly  impressed  upon  all  who  have  such  teeth 
in  their  mouth.] 

The  decay  of  the  teeth,  as  far  as  I  have  been  able  to 
judge,  does  not  appear  to  be  peculiar  to  any  age,  tempe- 
rament, or  state  of  health.  The  teeth  of  children  are 
very  subject  to  this  disease.  I  have  frequently  seen 
nearly  all  the  temporary  set  of  teeth  decayed;  and,  in 
two  or  three  instances,  I  have  attended  children  who 
have  been  so  constantly  tormented  with  the  tooth-ache  as 
to  make  it  necessary  to  extract  almost  all  their  teeth 
before  they  have  arrived  at  five  years  of  age. 

The  teeth  of  robust  and  healthy  persons  seem  to  be 
equally  liable  to  caries  as  those  of  the  delicate  and  less 
healthy.  Nosologists  mention,  as  one  of  the  characteristic 
marks  of  predisposition  to  phthisis,  sound  teeth  of  a  beau- 
tiful transparent  whiteness.  This  must  only  be  considered 
as  an  accidental  circumstance,  and  not  as  a  general  rule ; 
for  great  numbers  of  the  persons,  and  especially  those 
rather  more  advanced  in  years,  who  fall  victims  to  this 
disease,  have  lost  many  of  their  teeth.  The  observation 
applies  only  to  those  delicately-formed  persons  who,  un- 
happily, in  our  climate,  so  frequently  fall  victims  to  con- 
sumption. In  the  teeth  of  these  persons,  there  is  too 
small  a  quantity  of  earthy  matter  in  proportion  to  that  of 
the  animal  substance,  on  which  account  they  have  that 
fine  transparent  appearance. 


PREVENTION    OF    CARIES.  175 

[If  the  author  had  studied  closely  the  physical  character- 
istics of  the  teeth  of  different  individuals,  he  would  have 
discovered  that  temperament,  and  the  state  of  the  consti- 
tutional health  at  the  time  of  their  ossification,  had  much 
to  do  in  determining  their  susceptibility  to  the  action  of  the 
causes  that  produce  decay,  and  these  are  influenced  in  a 
great  degree,  by  residence  in  certain  localities  and  modes 
of  living.  But  for  a  full  exposition  of  the  editor's  views 
upon  this  subject,  the  reader  is  referred  to  Part  Second, 
Chapter  Second,  of  his  Principles  and  Practice  of  Dental 
Surgery.] 

Mr.  Hunter  thought  that  teeth  did  not  decay  after  a 
person  had  passed  fifty  years  of  age;  but  I  have  had  many 
opportunities  of  observing  that,  even  on  this  head,  no 
certain  opinion  can  be  formed ;  for  I  have  met  with  sev- 
eral persons  who  have  not  only  passed  fifty  years  without 
having  caries  in  their  teeth,  but  who  have  arrived  at  sixty 
without  having  felt  the  tooth-ache,  and,  after  that  period, 
have  been  obliged  to  have  several  teeth  extracted  on 
account  of  the  extreme  pain,  which  the  inflammation 
arising  from  caries  had  occasioned. 

[As  a  general  rule,  teeth  which  escape  the  attacks  of 
caries  until  the  fortieth  or  fiftieth  year  of  age,  rarely  suffer 
much  from  this  disease,  except  in  those  cases  where  the 
healthy  qualities  of  the  fluids  of  the  mouth,  from  general 
disease,  or  some  change  in  the  state  of  the  constitutional 
health,  become  impaired,  and  are  thereby  rendered  cor- 
rosive.] 

The  early  loss  of  teeth,  however,  cannot  be  considered, 
in  itself,  as  a  mark  of  short  life,  for  there  are  many 
persons  enjoying  the  most  healthy  old  age,  who  have  lost 
all  their  teeth  before  they  had  attained  thirty  or  forty 
years  of  age.  [This  remark  however,  applies  only  to 
those  whose  general  health  has  suffered  from  the  presence 


176  TREATMENT    OF    CARIES. 

of  diseased  teeth  and  gums;  and  the  improvement  of 
health  in  such  cases,  which  follows  the  loss  of  the  teeth, 
is  oftentimes  very  surprising.] 

TREATMENT    OF    CARIES. 

I  shall  now  proceed  to  state  the  mode  of  treatments 
necessary  to  be  adopted  in  the  different  stages  of  caries. 
In  the  preceding  pages,  I  have  shown  that  the  progress 
of  caries  may  be  retarded,  and  the  patient  be  preserved 
from  pain  by  keeping  the  cavity  of  the  tooth  constantly 
and  completely  stopped.  Beneficial  as  this  practice  really 
is,  there  are  some  cases  in  which  it  cannot  be  adopted ; 
such  are,  an  unfavourable  situation  of  the  decay,  or  its 
being  so  superficial  as  not  to  afford  depth  sufficient  to 
retain  the  gold  leaf. 

When  the  decay  is  situated  on  that  side  of  a  tooh  which 
is  in  opposition  to  another,  so  that  persons  say,  the  decay 
is  between  two  teeth,  it  is  always  difficult,  and  frequently 
impossible,  to  retain  the  stopping,  in  which  case,  great 
inconvenience  arises  from  the  food  lodging  in  those 
cavities,  whence  it  is  not  easily  removed;  great  benefit 
will  here  be  derived  from  passing  a  file  between  the  teeth, 
in  which  operation  the  opening  should  be  so  much 
enlarged  as  to  allow  a  quill  tooth-pick  to  be  used  with 
ease.  If  the  caries  has  affected  one  tooth  only,  the  next 
to  it  will  be  preserved  by  filing  away  as  much  of  the 
decay  as  possible,  and,  should  it  not  have  made  such  pro- 
gress into  the  body  of  the  tooth,  the  remainder  may  be 
preserved  for  a  number  of  years  by  the  removal  of  the 
more  carious  part. 

[When  the  decayed  part  cannot  be  removed  without 
filing  away  so  much  of  the  tooth  as  greatly  to  injure  its 
appearance,  after  having  formed  a  sufficiently  wide  aper- 


TREATMENT    OF    CARIES.  177 

ture  to  enable  the  operator  to  get  at  the  diseased  portion, 
this  should  be  removed  and  the  cavity  filled  with  gold  in 
the  manner  to  be  hereafter  described.] 

The  success  of  the  operation  of  filing  away  a  decayed 
portion  of  a  tooth  must  not  always  be  regarded  as  certain, 
the  decay  proceeds  so  rapidly,  that  it  cannot  be  checked 
by  any  means,  likewise  the  file  cannot  at  all  times  be  used, 
the  position  of  the  teeth  rendering  its  application  not  only 
inconvenient  but  impracticable. 

[Experience,  however,  has  proven,  that  this  is  one  of 
the  most  valuable  operations  in  dental  surgery,  but  in 
order  to  be  successful,  it  is  necessary  that  the  whole  of 
the  diseased  part  of  the  tooth  should  be  removed.  In 
another  place,  the  manner  in  which  the  operation  should 
be  performed  wTill  be  fully  described.] 

In  the  Natural  History  of  the  Human  Teeth,  p.  95,  I 
have  described  the  ill  effects  which  usually  arise  from  the 
incisores  being  too  closely  placed  against  each  other,  and  I 
there  stated  the  mode  of  obviating  them.  If  the  teeth,  in 
this  state,  have  been  neglected  until  persons  have  arrived 
to  adult  age,  considerable  advantage  will  be  obtained  from 
separating  them  by  a  very  thin  file,  as  it  is  on  the  sides  of 
these  teeth  that  the  caries  commences  in  the  form  of 
black  spots.  [It  has  been  already  stated,  that  this  opera- 
tion should  be  resorted  to  only  in  treatment  of  caries.] 

If  caries  has  proceeded  in  the  manner  delineated  in 
Plate  XVII.  Fig.  1,  a  file  rather  thicker  may  be  used,  so 
as  to  separate  the  teeth  as  in  Fig.  2.  If  one  tooth  only  be 
injured,  the  file  should  be  smooth  on  one  side,  in  order 
that  no  part  of  the  enamel  of  the  sound  one  may  be  re- 
moved. 

When  the  decay  has  considerably  advanced,  a  small 
round,  or  half-round  file  may  be  used,  and  it  should  be 
carried  into  the  mouth  in  an  oblique  direction,  so  as  to 


178  TREATMENT    OF    CARIES. 

preserve  as  much  as  possible  of  the  front  part  of  the  tooth ; 
should  the  filing  cause  much  pain,  from  the  great  sensi- 
bility of  the  tooth;  the  operation  ought  not  to  be  continued, 
as  it  may  render  the  patient  liable  to  future  tooth-ache, 
by  causing  an  exposure  of  the  nerve.  In  these  cases  we 
may  file  a  little  at  a  time  until  the  decay  has  been  nearly 
or  quite  eradicated,  recommending  during  the  intervals 
the  application  of  spirits  of  wine  to  the  decayed  parts, 
which  tends  to  harden  the  carious  substance  of  the  tooth 
and  to  diminish  its  sensibility.  [A  flat  file  should  always 
be  preferred  for  the  front  teeth,  and  experience  has  de- 
monstrated that  it  is  better  to  complete  the  operation  at 
one  sitting,  even  though  the  tooth  be  sensitive,  and  no 
advantage  whatever  is  derived  from  the  application  of 
spirits  of  wine  as  recommended  by  the  author.]  Sup- 
posing the  decay  to  have  extended  into  the  cavity  of  the 
tooth,  it  will  be  better  to  omit  the  filing  altogether,  and 
endeavour  to  stop  it  with  gold  leaf.  [In  many  cases 
where  the  decay  has  extended  thus  far,  neither  filing  nor 
plugging  will  save  the  tooth.] 

[It  will  be  seen  from  the  foregoing  remarks,  that  the 
treatment  of  caries  is  comprised  in  two  operations,  namely 
filing  and  plugging,  and  the  manner  of  performing  which 
will  now  be  described.] 


CHAPTER    SECOND. 


OF    FILING    THE    TEETH. 


The  application  of  a  file  to  the  teeth  is  considered  by 
some  persons,  as  one  of  the  most  injurious  practices 
which  can  be  performed;  and  they  think  that  the  decay 
of  the  tooth  will  certainly  follow  the  removal  of  the  least 
portion  of  enamel.  These  opinions  have  been  dissemi- 
nated by  certain  empirics,  who  have  considered  diseases 
of  the  teeth  as  a  source  of  profit,  and  have  therefore,  paid 
no  regard  to  the  correctness  of  their  statements,  provided 
that  they  could  acquire  gain. 

In  those  cases  of  caries  where  filing  has  been  recom- 
mended to  retard  its  progress,  the  most  decided  advan- 
tages were  promised;  and  it  is  a  practice  defensible  on 
the  most  just  principles.  Caries  is  a  disease  which  it  is 
not  in  our  power  entirely  to  arrest  by  any  remedy  what- 
soever: its  progress  is  gradual,  but  certain,  until  the  de- 
struction of  the  tooth  is  effected.  The  only  plan  that 
promises  success,  is  to  remove  the  carious  part  from  that 
which  is  sound,  with  the  expectation  that  the  disease 
will  thereby  be  stopped.  This  theory  is  justified  by  the 
success  of  the  practice,  whenever  it  is  adopted  before  the 
caries  have  reached  the  internal  cavity  of  the  tooth. 

The  decay  of  a  tooth  is  never  occasioned  by  the  loss  of 
a  part  of  the  enamel,  provided  it  be  superficial,  and  not 
entering  the  cavity :  this  is  frequently  seen  in  those  cases 


180  OF    FILING    THE  TEETH. 

where  a  piece  of  a  tooth  has  been  broken  off,  and  caries 
has  not  been  produced.  In  like  manner,  a  considerable 
portion  of  a  tooth  may  be  filed  away  and  the  remainder 
will  continue  perfectly  sound. 

These  facts  may  be  well  illustrated  by  stating  the  cus- 
toms of  some  savage  nations;  these  people  have  many 
customs,  in  which  doing  something  to  the  teeth  forms  an 
essential  part  of  the  ceremony.  In  New  Holland,  the 
beating  out  one  of  the  lateral  incisores  is  performed  by 
the  priest,  when  a  youth  has  gone  through  various  cere- 
monies previous  to  his  being  introduced  into  the  class  of 
warriors.  In  one  of  the  tribes  of  New  Zealand,  the 
queen  is  distinguished  by  having  a  piece  of  gold  substi- 
tuted for  her  two  front  teeth.  Upon  the  effects  of  filing 
the  teeth,  the  Abyssinian  Negroes  and  the  Malay  Indians 
furnish  striking  examples.  The  Abyssinian  Negroes 
have  a  method  of  cutting  off  the  corners  of  the  cutting 
edges  of  the  incisores  in  both  jaws,  in  order  to  make  them 
all  into  pointed  teeth;  this  operation  they  perform  with- 
out entering  any  part  of  the  cavity.*  Mr.  Cline  was  in 
possession  of  a  scull  of  one  of  these  Negroes,  in  which, 
although  it  bore  the  marks  of  having  belonged  to  a  man 
who  had  been  somewhat  advanced  in  years,  the  teeth, 
thus  filed,  were  not  in  the  least  rendered  carious.  A 
most  convincing  proof  that  the  mere  filing  of  a  tooth  does 
not  cause  it  to  decay.  The  other  example  in  the  custom 
of  the  Malay  Indians,  consists  in  filing  the  incisores  of  the 
upper  jaw,  in  a  direction  across  the  upper  part  of  the 
anterior  surface,  so  as  to  give  them  the  appearance  of 
being  fluted.  By  this  mode  of  filing  the  teeth,  the  enamel 
is  not  only  removed,  but  the  cavities  in  the  teeth  are 
more  or  less  exposed:  the  consequence  of  this  is,  that 
the  teeth  soon  become  carious.     I  had  an  opportunity, 

•Plate  XXII.  Fi?.  5. 


OF    FILING    THE    TEETH.  181 

some  time  back,  of  examining  the  teeth  of  three  of  these 
men:  they  were  all  filed  as  represented  in  Plate  XXII, 
Fig.  4.  In  those  teeth  which  had  the  cavities  exposed, 
caries  had  taken  place,  and  those  remained  sound  from 
which  little  more  than  the  enamel  had  been  taken  off. 
These  facts  demonstrate  that  the  teeth  are  not  rendered 
carious  by  filing,  excepting  when  any  part  of  the  cavity 
is  exposed. 

The  incisores  of  the  upper  jaw,  as  I  have  already  shown, 
are  very  liable  to  become  carious,  in  consequence  of  being 
crowded,  or  pressed  much  against  each  other.  To 
prevent  this  disease  from  taking  place,  it  is  advisable  to 
make  a  separation  between  each  tooth  with  a  very  thin 
file;  and  the  space  ought  not  to  be  wider  than  to  allow  a 
piece  of  paper,  or  fine  linen,  to  be  passed  between  the 
teeth.  If  the  teeth  have  begun  to  be  carious,  a  wider 
space  should  be  made.  In  case  one  tooth  should  be 
carious,  and  the  next  to  it  perfectly  sound,  then  the  file 
should  be  smooth  on  one  side,  which  will  save  the  sound 
tooth  from  being  injured. 

Sometimes  there  is  so  much  sensibility  in  the  teeth, 
that  filing  causes  pain;  here  it  will  be  proper  to  file  but  a 
little  at  a  time,  until  the  decayed  part  is  removed.  If  the 
decay  appear  to  have  entered  the  cavity  of  a  tooth,  it 
will  be  advisable  not  to  touch  it  with  the  file.  In  that 
disease  of  the  alveolar  processes,  where  the  teeth  are 
protruded  from  the  socket,  the  tooth  should  be  made  firm 
to  the  side  teeth,  by  means  of  a  ligature,  previous  to 
making  use  of  the  file;  the  projecting  piece  may  then  be 
filed  off  without  causing  any  disagreeable  jar  or  shaking 
of  the  tooth.  In  filing  off  the  ragged  points  of  broken 
teeth,  no  other  direction  is  required  than  not  to  make  use 
of  a  coarse  file ;  fine  Lancashire  files  are  the  most  proper 
for  all  these  purposes, 
21 


182  OF    FILING    THE    TEETH. 

[It  is  sometimes  necessary,  from  the  peculiar  nature  of 
the  decay  to  file  away  a  considerable  portion  of  the  tooth, 
and  in  doing  which,  it  is  important  that  the  symmetry  of 
the  organ,  as  far  as  practicable,  should  be  preserved. 
Anteriorly,  the  aperture  should  be  no  wider  than  is  neces- 
sary to  admit  of  a  sufficiently  oblique  motion,  of  a  safe- 
sided  separating  file,  for  the  removal  of  the  caries.  A 
third,  on  even  more,  of  a  tooth,  may,  in  this  way,  be  re- 
moved without  materially  injuring  the  appearance  of  the 
organ  anteriorly. 

It  has  been  before  remarked,  that  in  filing  the  teeth,  it 
should  be  done  in  such  manner  as  to  prevent  the  filed 
surfaces  from  coming  together.  To  prevent  which,  a 
projection  should  be  left  on  each  tooth  near  the  gum. 
Where  the  approximal  sides  of  two  incisores  are  decayed, 
an  equal  portion,  as  nearly  as  the  circumstances  of  the 
case  will  permit,  should  be  removed  from  each  tooth. 

During  the  operation,  the  file  should  be  frequently 
dipped  in  water,  lukewarm,  if  cold  causes  an  unpleasant 
sensation.  After  the  removal  of  the  caries,  the  filed  sur- 
faces should  be  made  smooth  with  a  very  fine  half-worn 
file  and  burnisher.  The  edges  and  sharp  corners  should 
next  be  removed  and  made  smooth  to  prevent  annoyance 
to  the  tongue  and  lips  of  the  patient. 

The  operator,  in  filing  the  front  teeth  and  those  of  the 
right  side  of  the  mouth,  should  stand  at  the  right  and 
a  little  behind  the  patient,  steadying  his  head  with  his 
left  arm,  while  with  the  fingers  of  the  same  hand  he 
raises  and  retracts  his  lips  and  properly  exposes  his  teeth 
for  the  operation.  Then  writh  the  file  firmly  grasped 
between  the  thumb  and  middle  finger  of  the  right  hand, 
with  the  end  of  the  fore-finger  resting  on  its  edge  near 
the  extremity,  the  operation  should  be  commenced  by 
moving   it  backwards  and   forwards  in   a  straight  line. 


OF    FILING    THE    TEETH.  183 

When  both  teeth  are  affected  with  caries,  a  file  cut  on 
both  sides  of  about  half  a  line  in  thickness,  should  first  be 
used,  and  after  having  passed  this  between  them,  the 
balance  of  the  operation  should  be  completed  with  a  safe- 
sided  file  of  about  the  same  thickness.  If  only  one  tooth 
is  affected,  the  operation  should  be  commenced  and  com- 
pleted with  a  file  of  the  description  last  named. 

For  the  bicuspides,  a  file  shaped  like  the  pinion-file  of 
a  clock,  or  one  that  is  oval  on  one  side  and  flat  on  the 
other,  will  be  found  the  best  adapted  for  the  operation,  as 
the  aperture  to  be  formed  should  be  made  to  resemble 
somewhat  the  letter  V,  except  that  the  angle  at  the  gum 
where  it  should  terminate,  should  be  less  acute.  The  ap- 
proximation of  the  teeth  will  be  prevented  by  an  aperture 
between  them  of  this  shape,  and  should  plugging  become 
necessary,  the  dentist  will,  without  difficulty,  be  enabled 
to  perform  the  operation  in  the  most  perfect  manner. 

When  it  becomes  necessary  to  separate  the  molares,  a 
similar  shaped  aperture  should  be  formed,  but  as  these 
teeth  are  situated  farther  back  in  the  mouth,  it  cannot 
always  be  clone  with  a  straight  file.  To  obviate  this  diffi- 
culty, operators  have  been  in  the  habit  of  employing  an 
instrument,  with  which  every  dentist  is  familiar,  denomi- 
nated, a  file-carrier,  but  as  this,  for  many  reasons,  is  not 
very  well  suited  to  the  purpose,  the  editor  has  used  for 
several  years  files  which  he  had  made  expressly  for  these 
teeth.  They  are  in  pairs,  or  rights  and  lefts,  about  an 
inch  and  a  half  in  length  and  shaped  something  like  the 
pinion-file  of  a  clock,  with  a  handle  to  each,  bent  so 
that  they  may  be  used  without  interfering  with  the  corners 
of  the  mouth.  These  files,  together  with  others  of  a 
somewhat  similar  construction,  are  now  used  by  many 
dentists,  and  are  highly  approved. 

To  many,  the  sensation  produced  by  the  action  of  the 


]84  OF    FILING    THE    TEETH. 

file  on  the  teeth  is  exceedingly  disagreeable,  and  to  some 
quite  painful,  but  the  operation  should  never  be  suspended 
on  this  account.  The  teeth  too,  after  having  been  filed, 
are  often  exceedingly  susceptible  to  heat  and  cold,  so 
much  so,  in  fact,  as  to  be  more  or  less  painful  when  any 
thing  hot  or  cold  is  taken  into  the  mouth.  But  this  sus- 
ceptibility soon  subsides,  generally  in  a  few  days,  without 
causing  any  other  inconvenience. 

After  the  operation  has  been  completed  the  patient 
should  be  directed  to  keep  the  filed  surfaces  of  the  teeth 
constantly  clean.  The  observance  of  this  precaution  is 
absolutely  necessary  to  prevent  a  recurrence  of  the  dis- 
ease for  which  it  was  performed.] 


CHAPTER    THIRD. 

OF    STOPPING    [PLUGGING]    THE    TEETH. 

Jt  frequently  happens  that  persons  apply  to  have  this 
operation  performed,  with  an  expectation  that  it  will 
relieve  the  tooth-ache :  the  error  of  this  opinion  will  ap- 
pear, when  it  is  considered  that  tooth-ache,  being  a  con- 
sequence of  inflammation,  can  only  be  relieved  by  such 
applications  as  diminish  increased  action. 

The  cavity  of  an  inflamed  tooth  is  commonly  so  very 
sensible,  that  even  the  accidental  entrance  of  any  substance 
will  cause  the  most  acute  pain;  hence  an  endeavour  to 
fill  up  the  cavity  of  a  tender  tooth,  with  any  material  that 
requires  pressure,  would  increase  all  those  sufferings  from 
which  it  is  the  desire  of  the  patient  to  be  relieved.  A 
tooth  then  can  only  be  stopped  when  it  is  perfectly  free 
from  pain  or  tenderness. 

By  stopping  a  tooth,  it  is  rendered  artificially  sound 
again.  The  carious  cavity  being  completely  filled  up, 
the  introduction  of  particles  of  food,  and  that  taint  of  the 
breath  which  arises  from  their  becoming  putrid,  are  pre- 
vented; the  nervous  membrane,  in  the  natural  cavity,  is 
preserved  from  being  irritated,  and  is  rendered  less  sus- 
ceptible of  changes  of  temperature  in  the  articles  of  food : 
and,  if  care  be  taken  to  keep  the  stopping  in  a  complete 
state,  the  progress  of  decay  is  very  retarded,  and  the 
tooth-ache  almost  prevented.     I  am  acquainted  with  per 


186  OF    STOPPING    THE    TEETH. 

sons  who  have  had  carious  teeth  for  several  years,  but 
who  have  never  felt  the  tooth-ache,  from  keeping  the 
cavities  in  their  teeth  constantly  stopped. 

[The  value  of  the  operation  however,  depends  upon 
its  being  well  performed,  and  with  an  indestructable  ma- 
terial. When  thus  performed,  and  with  such  material, 
the  preservation  of  the  tooth,  unless  it  be  attacked  by 
caries  in  some  other  place  and  no  means  used  to  arrest 
its  progress  there,  may  be  regarded,  in  almost  every  in- 
stance, as  certain;  but  when  performed  by  an  unskilful 
hand,  or  with  a  bad  material,  it  has  a  contrary  effect — it 
often  hastens,  rather  than  arrests,  the  progress  of  the  dis- 
ease. Although  to  one  inexperienced  in  this  branch  of 
manual  medicine,  the  operation  may  appear  very  simple, 
yet  it  is  the  most  difficult  one  in  dental  surgery.  It,  in 
fact,  requires  so  great  an  amount  of  mechanical  aptitude 
and  practical  skill,  that  hardly  one  in  fifty,  engaged  in 
this  department  of  physical  alleviation,  have  acquired  an 
eminent  degree  of  excellence  in  it.  At  the  time  of  the 
publication  of  the  first  edition  of  this  work,  it  was  but 
little  understood,  and  consequently,  the  directions  given 
by  the  author  for  its  performance  are  too  brief,  and  inex- 
plicit to  serve  as  a  proper  guide  to  the  student.  There- 
fore, the  editor  has  thought  it  best  to  omit  them  alto- 
gether. 

As  a  general  rule,  the  operation  should  be  performed 
before  the  pulp  cavity  of  the  tooth  has  been  reached  by 
the  disease,  for  after  the  lining  membrane  has  become  ex- 
posed, its  success,  especially  on  a  molaris,  in  at  least  four 
cases  out  of  five  is  rendered  hopeless.  A  filling  may  often 
be  introduced  into  a  cavity  in  the  side  of  a  bicuspis,  cus- 
pidatus  or  incisor,  which  extends  in  to  the  lining  mem- 
brane, without  touching  it,  and  in  such  a  manner  as  to 
secure  the  preservation  of  the  tooth.     But  to  do  this, 


OF    STOPPING    THE    TEETH.  187 

much  mechanical  tact  and  practical  experience  is  re- 
quired^ for  if  the  filling  touch  the  lining  membrane,  the 
pain  and  inflammation  it  will  excite  will  render  its  remo- 
val indispensable. 

It  is  seldom  proper  to  plug  a  tooth  after  the  destruction 
of  its  lining  membrane,  except  it  be  an  incisor  or  cuspi- 
datus,  and  even  then  the  success  of  the  operation  is  very 
doubtful.  A  tooth  after  being  deprived  of  the  greater 
portion  of  its  vitality,  becomes  more  or  less  obnoxious  to 
the  periosteal  tissue  of  its  socket.  It  causes  it  to  become 
thickened  about  the  extremity  of  its  root  or  roots,  if  it 
have  more  than  one,  and  a  morbid  secretion,  which  is  con- 
stantly discharged  through  the  tooth,  so  long  as  the  cavity 
remains  open.  If  this  be  closed  by  a  filling,  the  matter 
accumulates,  and  ultimately  in  the  majority  of  cases, 
makes  a  passage  for  its  escape  through  the  alveolus  and 
gum  or  into  the  antrum.  This,  however,  is  not  so  fre- 
quently the  case  with  the  incisores  and  cuspidati,  as  with 
the  bicuspides  and  molares,  and  probably,  for  the  reason 
that  the  roots  of  the  former  derive  a  greater  amount  of 
vitality  from  their  investing  membrane  than  do  the  latter, 
and  are  hence,  after  the  destruction  of  their  lining  mem- 
brane, productive  of  less  irritation  to  the  surrounding 
parts. 

The  accumulation  of  matter,  however,  secreted  at  the 
extremity  of  the  root,  may  be  prevented,  by  leaving  an 
opening  through  the  filling,  as  proposed  by  Dr.  L.  S. 
Parmly,  which  is  done  by  introducing  the  foil  round  a 
small  probe  or  wire,  with  one  end  resting  on  the  bottom 
of  the  pulp  cavity,  and  which,  after  the  operation  is  com- 
pleted, is  to  be  withdrawn.  But  while  the  decay  of  the 
tooth  immediately  around  the  filling  is  thus  prevented,  it 
is  constantly  going  on  interiorly,  and  ultimately  destroys 
the  tooth.     The  practice,  therefore,  of  filling  the  bicus- 


188  OF    STOPPING    THE    TEETH. 

pides  and  molares  after  the  destruction  of  their  lining 
membrane,  whether  by  the  process  of  inflammation  and 
suppuration,  or  by  arsenic  or  any  other  means,  is,  to 
say  the  least  of  it,  unscientific,  and  should  never  be 
adopted,  except  when  called  for  by  some  peculiar  neces- 
sity. Nor  should  a  front  tooth,  from  the  root  of  which 
fetid  matter  is  discharged,  ever  be  filled. 

In  cases  of  exposure  and  inflammation  of  the  lining 
membrane,  Dr.  Koecker  recommends  the  application  of 
leaf  lead,  previously  to  the  introduction  of  the  gold,  sup- 
posing the  former  is  less  irritating  to  the  animal  fibre 
than  the  latter,  but  the  contact  of  any  hard  substance 
with  as  sensitive  a  tissue  as  is  this  membrane,  would  of 
necessity  increase  the  disturbance.  The  practice  recom- 
mended by  Dr.  Fitch,  which  consists  in  covering  the 
exposed  nerve  with  a  gold  plate,  and  in  such  a  way  that 
it  shall  not  come  in  contact  with  it,  is  altogether  pre- 
ferable. The  plate,  however,  should  be  so  fitted  to  the 
walls  of  the  cavity  as  to  prevent  it  from  touching  the 
bottom  or  from  becoming  displaced  by  the  introduction  of 
the  filling.  But  when  the  lining  membrane  is  inflamed, 
Dr.  F.  recommends  the  application  of  Aleppo  galls  to 
it,  for  the  purpose  of  reducing  the  inflammation,  pre- 
viously to  filling  the  tooth.  The  editor,  however,  has 
seldom  derived  any  advantage  from  the  application  of  this 
remedy.  Some  benefit  may  occasionally  be  derived  from 
the  application  of  leeches  to  the  gum,  but  neither  by  this 
nor  any  other  treatment  that  has  ever  been  adopted,  can 
inflammation  of  this  tissue  be  always  reduced.  In  fact,  it 
is  only  in  the  fewest  number  of  cases  that  it  can  be. 

It  oftentimes  happens  that  a  tooth  is  very  sensitive 
when  the  decay  has  penetrated  but  a  short  distance  into 
its  osseous  structure.  This,  however,  need  never  prevent 
the  dentist  from  proceeding  with  the  operation,  provided 


OF    STOPPING    THE    TEETH.  \gg 

the  patient  can  be  prevailed  upon  to  endure  the  pain  con- 
sequent upon  the  removal  of  the  diseased  part,  for,  after 
he  has  accomplished  this,  it  is  seldom  that  any  other  in- 
convenience will  afterwards  be  experienced. 

From  the  foregoing  remarks,  it  will  be  perceived,  that 
the  plugging  of  teeth  is  advisable  only  under  certain 
circumstances,  and  to  which  reference  should  always  be 
had  in  the  performance  of  the  operation.  And  now, 
having  premised  these  few  general  observations  on  the 
subject,  it  may  be  well,  before  describing  the  manner  of 
performing  the  operation,  to  say  a  few  words  concerning 
the  materials  employed  for  the  purpose,  and  upon  this 
point,  we  shall  be  brief. 

Various  articles  and  preparations  have  been  employed 
for  filling  teeth,  and  hardly  a  month  passes,  that  we  do 
not  hear  of  the  discovery  of  some  new  material  or  nos- 
trum, recommended  by  the  discoverer  as  being  superior 
to  anything  previously  used  for  the  purpose.  But  pure 
gold  or  platina  is  the  only  material  capable,  under  all 
circumstances,  of  resisting  the  action  of  the  secretions  of 
the  mouth,  and  is  the  only  one  that  should  ever  be  em- 
ployed for  filling  teeth.  Gold  is  softer  and  can  be  more 
easily  introduced  into  the  cavity  of  a  tooth  than  platina, 
and  for  which  reason,  is  altogether  and  by  far  preferable 
to  that  metal.  This,  when  properly  prepared  in  leaves 
of  from  four  to  ten  or  twelve  grains,  can  be  so  packed  in 
the  cavity  of  a  tooth  as  to  exclude  every  particle  of  mois- 
ture, which  is  indispensable  to  the  preservation  of  the 
organ.  With  this  metal,  the  object  for  which  the  opera- 
tion is  performed,  may  with  certainty  be  secured.  It  is 
therefore  good  enough;  no  better  material  is  wanted,  and 
indeed,  none  better  can  be  had. 

Tin  is  the  next  best  material.  This  metal  is  very  soft, 
and  can  be  easily  and  compactly  introduced  in  the  cavity 
25 


190  OF    STOPPING    THE    TEETH. 

of  a  tooth;  but  in  consequence  of  its  being  more  easily 
acted  upon  by  the  secretions  of  the  mouthy  it  is  of  a  less 
durable  nature;  though  in  the  mouth  of  a  healthy  person, 
it  will  often  last  for  many  years,  and  sometimes  through 
life.  But  inasmuch  as  it  cannot  be  depended  on  in  all 
cases,  and  under  all  circumstances,  we  are  of  the  opinion 
that  it  should  never  be  employed. 

Silver  is  even  more  objectionable  than  tin.  It  is  much 
harder  and  cannot  be  so  firmly  packed,  and  besides  it 
oxydizes  more  readily;  consequently, it  is  at  present  little 
used  for  filling  teeth :  Lead,  a  few  years  ago  was  much 
employed  for  this  purpose,  but  in  consequence  of  its  being 
easily  decomposed  by  the  septic  (nitrous)  acid  of  the 
mouth,  its  use  has  been  almost  wholly  abandoned.  An 
alloy  of  bismuth,  tin,  and  lead,  in  consequence  of  its  fusi- 
bility at  the  temperature  of  boiling  water,  was  at  one 
time  recommended.  This,  however,  was  never  much 
used,  as  it  was  found,  that  the  temperature  at  which  it  had 
to  be  used,  caused  inflammation  in  the  lining  membrane  of 
the  tooth,  and  that  when  it  cooled,  it  shrunk  and  admitted 
the  fluids  of  the  mouth  around  it  into  the  cavity  of  the 
organ. 

The  most  objectionable  and  pernicious  article  that  has 
ever  been  employed  for  filling  a  tooth,  is  an  amalgum  of 
mercury  and  silver,  known  by  the  various  names  of 
lithodeon,  mineral  cement,  &lc.  &lc.  This  preparation  not 
only  readily  oxydizes  in  the  mouth,  but  it  also  turns  the 
teeth  black,  causes  them  to  decay  more  rapidly  than  they 
would  do  if  let  alone.  It  moreover,  exerts  a  hurtful 
influence  upon  the  alveolo-dental  periosteal  tissue,  gums, 
and  in  fact  the  whole  body.  A  number  of  clearly  marked 
cases  of  silivation  produced  by  the  use  of  this  amalgum 
have  fallen  under  the  observation  of  the  editor,  yet  it 
has  been  most  extravagantly  eulogized  by  a  few  unscru- 


OF    STOPPING    THE    TEETH.  191 

pulous  empirics,  during  the  last  six  or  seven  years,  and 
thousands  of  teeth  both  in  America  and  Europe  have 
been  destroyed  by  it. 

Having  said  thus  much  concerning  the  materials  em- 
ployed for  filling  teeth;  we  shall  now  proceed  to  offer  a 
few  remarks  on  the  instruments  for  and  manner  of  pre- 
paring the  cavity,  and  for  this  part  of  the  operation,  a 
variety  of  delicately,  different  shaped,  and  well  tempered 
instruments  are  required,  which  are  designated  by  the 
name  of  excavators.  They  should  be  so  curved  and 
shaped  at  their  points  as  to  be  easily  applied  to  any  part 
of  the  tooth,  and  each  one  should  have  a  sharp  cutting 
edge,  which  may  be  made  to  act  with  facility  upon 
every  part  of  the  caries  and  walls  of  the  cavity,  it  may  be 
necessary  to  form  for  the  retention  of  the  filling.  Each 
may  have  a  separate  handle  or  be  made  to  fit  in  a  socket 
fixed  to  one  common  handle.  It  would  be  well  however 
for  every  operator  to  be  provided  with  a  good  supply 
of  both  kinds,  and  in  case  of  necessity  he  should  be 
able  to  make  them  himself;  for  without  such  as  are 
exactly  suited  to  each  individual  case,  he  will  not  only 
labour  under  great  inconvenience,  but  oftentimes  be  un- 
able to  form  the  cavity  in  the  best  and  most  proper 
manner. 

In  addition  to  the  foregoing  instruments,  cherry-headed 
and  flat  drills  are  oftentimes  exceedingly  useful  in  some 
portions  of  this  part  of  the  operation.  They  may  be  used 
either  in  a  socket  handle  or  drill-stock.  The  latter  may 
be  turned  with  the  thumb  and  forefinger  or  a  string  and 
bow.  Some  practitioners,  without  reason,  but  on  the 
alleged  ground  that  the  more  rapid  motion  which  is  thus 
given  to  the  instrument,  causes  a  greater  amount  of  ir- 
ritation to  the  bone  of  the  tooth,  object  to  the  latter 
method  of  using  it.     In  the  hands  of  a  skilful  operator  it 


192  OF    STOPPING    THE    TEETH. 

may  be  used  in  this  way  with  impunity,  and  frequently 
with  great  advantage,  especially  in  opening  a  cavity  on 
the  grinding  or  outer  surface  of  a  molaris.  But  for  this, 
the  cherry-headed  drill  should  be  employed.  The  flat- 
drill  too,  in  many  cases  is  very  useful.  A  cavity  in  a  tooth 
however,  can,  without  the  aid  of  other  instruments,  seldom 
be  properly  formed  with  either  of  these.  They  are  chiefly 
useful  for  opening  and  enlarging  the  orifice,  and  this 
done,  its  formation  should  be  completed  with  properly 
shaped  excavators,  and  in  the  majority  of  cases,  the 
whole  of  this  part  of  the  operation  should  be  performed 
with  these  instruments.  When  the  drill  is  used,  the 
precaution  of  dipping  it  frequently  in  water,  to  prevent 
it  from  becoming  heated,  should  never  be  neglected. 

The  forming  of  a  properly  shaped  cavity,  preparatory 
to  plugging  a  tooth,  is  an  important  part  of  the  operation; 
and  though  generally  the  easiest,  is  nevertheless  sometimes 
attended  with  difficulty.  The  removal  of  every  portion 
of  the  caries,  is  not  all  that  is  required  in  the  formation  of 
the  cavity — it  often  becomes  necessary  to  cut  away  some 
of  the  sound  part  of  the  tooth,  to  give  to  it  the  proper 
shape  for  the  retention  of  the  gold.  It  should  always, 
if  possible,  be  as  large  at  the  bottom  as  at  the  orifice, 
and  if  there  be  any  difference,  it  should  be  rather  larger 
here  than  there,  though  the  dimensions  of  the  former 
should  never  greatly  exceed  that  of  the  latter.  The  walls 
of  the  cavity  too,  surrounding  the  orifice  should  be  strong 
and  smooth,  presenting  no  unequal  or  brittle  edges.  It 
sometimes  happens  however,  that  the  extent  and  peculiar 
limits  of  the  decay  is  such,  as  to  render  it  impracticable  to 
make  the  bottom  of  the  cavity  as  large  as  the  orifice.  In 
this  case,  a  firm  support  should  be  secured  for  the  filling, 
by  cutting  several  circular  grooves  in  the  wralls  of  the 
cavity.  This  precaution,  if  properly  attended  to,  will 
prevent  the  filling  from  becoming  displaced. 


OF    STOPPING    THE    TEETH.  193 

It  is  generally  much  easier  to  form  a  cavity  in  the 
grinding  surface  of  a  molaris  or  bicuspis,  than  in  any 
other  part  of  these,  or  any  of  the  other  teeth.  But  there 
are  cases,  in  which,  the  formation  of  a  properly-shaped 
cavity,  even  in  the  grinding  surface  of  a  molaris  is  very 
difficult,  especially  when  the  caries,  having  attacked  the 
centre  of  the  tooth,  follows  the  various  indentations  or 
depressions  which  leads  out  in  various  directions  from 
it.  The  caries,  after  having  attacked  the  tooth,  spreads 
as  it  penetrates  it,  and  it  is  necessary  to  cut  away  the 
points  at  least,  of  the  intermediary  converging  portions  of 
the  enamel,  in  order  to  make  a  sufficiently  large  orifice, 
and  these  are  often  very  thick  and  hard,  requiring  consid- 
erable time  to  do  it.  When  the  caries  is  situated  in  the 
approximal  side  of  a  tooth  or  sides,  as  is  most  frequently 
the  case,  it  should  first  be  exposed  by  filing  a  space 
between  the  organs  in  the  manner  as  before  described, 
and  this  should  always  be  wide  enough  to  enable  the 
operator  to  remove  with  facility  the  caries  and  fill  the 
cavity. 

To  fill  a  tooth  well  when  the  cavity  is  situated  in  its 
side  next  an  adjoining  tooth  is  often  a  very  nice  and 
exceedingly  difficult  operation.  It  was  formerly  regarded 
as  impracticable,  but  its  practicability  is  now  fully  estab- 
lished. An  experienced  and  skilful  practitioner  can  put 
in,  under  favourable  circumstances,  as  substantial  and 
durable  a  filling  here,  as  in  any  other  part  of  a  tooth. 

After  the  formation  of  the  cavity  is  completed,  it  should 
be  wiped  out  and  freed  from  all  loose  particles  of  matter, 
before  the  introduction  of  the  filling. 

The  next  step  in  the  operation  is  the  introduction  of 
the  gold,  and  this  is  by  far  the  most  difficult  part,  requir- 
ing ordinarily  more  time  and  mechanical  skill  in  its  exe- 
cution.    A  number  of  instruments  are  required  for  the 


194  OF    STOPPING    THE    TEETH. 

purpose.  Some  dentists  employ  more  than  others,  and 
the  majority  of  practitioners  have  more  than  is  absolutely 
necessary.  With  from  twelve  to  fifteen,  properly  con- 
structed, a  good  operator  will  be  able  to  fill  any  cavity  in 
any  tooth.  Those  generally  employed,  are  illy  suited  to 
the  purpose.  Filling  instruments  should  be  made  of  the 
best  of  steel,  have  a  spring  temper  and  be  strong  enough 
to  bear  all  the  pressure  the  operator  is  capable  of  putting 
on  them.  Their  points  should  be  shaped  so  that  they  may 
be  applied  to  any  cavity  in  any  tooth — some  should  be 
curved  slightly,  others  to  an  angle  of  ninety  degrees,  and 
others  again  should  be  straight.  Most  of  them  should  be 
shaped  like  a  thin  wedge,  especially  those  that  are  to  be 
used  for  the  introduction  of  the  foil.  A  few  should  have 
blunt  and  some  oval  points,  and  they  should  vary  in  size 
to  suit  the  cavity  in  the  tooth,  and  they  should  be  se- 
curely fixed  in  strong  octangular  handles. 

Being  provided  with  a  sufficient  number  of  properly 
shaped  instruments,  the  operator  should  cut  his  gold  foil 
in  strips  of  from  half  an  inch  to  an  inch  in  width.  These 
should  be  loosely  rolled  or  folded  lengthwise,  and  begin- 
ning at  one  end,  it  should  be  introduced,  with  a  wedge- 
pointed  instrument,  in  folds,  commencing  on  the  side  of 
the  cavity,  making  one  end  of  each  of  which,  press  on 
the  bottom  while  the  other  projects  a  short  distance  out 
of  the  orifice.  Thus  fold  after  fold,  and  piece  after  piece 
should  be  introduced  until  it  is  tolerable  tightly  filled. 
This  done  the  point  of  the  instrument  should  be  forced 
down  through  the  centre  of  the  filling  and  the  gold  firmly 
pressed  out  against  the  walls  of  the  cavity.  The  opening 
thus  made  should  next  be  filled  in  the  manner  as  first 
described.  Every  part  of  the  filling  should  now  be  tried 
with  a  tolerably  sharp  wedge-pointed  instrument,  and 
an  opening  effected  similar  to  the  first,  and  filled  as  before 


OF    STOPPING    THE    TEETH.  195 

described^  whenever  it  can  be  made  to  penetrate  the 
gold.  After  having  put  in  as  much  foil  as  can  possibly  be 
introduced^  the  part  projecting  out  of  the  cavity  should 
be  packed,  if  it  be  in  any  part,  except  the  approximal 
surfaces  of  the  teeth,  with  a  blunt-pointed  instrument, 
and  if  here  with  the  side  of  a  wedge-pointed  one,  with 
as  much  force  as  can  be  applied,  or  as  the  tooth  will  bear. 

If  the  filling  be  in  the  grinding,  labial  or  lingual  surface 
of  the  tooth,  so  much  of  it  as  still  protrudes  should  be 
scraped  or  cut  away,  leaving  it  however  flush  with  every 
part  of  the  cavity,  and  the  surface  highly  polished.  If 
the  filling  be  on  the  approximal  surface  of  the  tooth  the 
extruding  portion  should  be  removed  with  a  very  fine  or 
half  worn  file,  and  polished  as  before  stated. 

Too  much  labour  and  pains  cannot  be  bestowed  on  the 
introduction  and  finishing  of  the  filling.  The  gold  should 
be  thoroughly  packed,  and  inserted  in  folds  as  just  de- 
scribed to  prevent  the  liability  of  its  crumbling.  If  in 
finishing  the  filling,  any  small  particle  should  crumble  or 
be  displaced  next  the  wall  of  the  cavity,  an  opening 
should  be  made  here,  deep  enough  for  the  introduction 
of  more  gold,  so  that  when  the  operation  is  completed, 
it  shall  present  a  firm,  uniform,  unbroken  and  highly 
polished  surface. 

When  the  lining  membrane  is  exposed,  the  folds  of  the 
foil  should  not  be  carried  to  the  bottom  of  the  cavity,  and 
in  packing  it,  the  instrument  should  be  forced  down  at 
the  side,  instead  of  through  the  centre  of  the  filling,  as 
before  described.  It  is  seldom,  however,  that  any  other 
tooth  than  a  bicuspis,  cuspiclatus  or  incisor  can  be  filled 
under  such  circumstances,  and  even  then  it  cannot  always 
be  done,  and  never,  except  by  a  very  skilful  operator.] 

Having  stated,  in  the  preceding  pages,  the  causes  of 
caries,  and  described  its  progress  in  destroying  the  teeth, 


196  OF    STOPPING    THE    TEETH. 

it  now  becomes  necessary  to  treat  of  the  symptoms  of 
inflammation,  which  usually  attend  this  disease,  and  the 
occasional  consequent  affections  of  the  contiguous  parts. 
[As  the  symptoms  to  which  the  author  refers,  belong 
strictly  to  tooth-ache,  and  are  comparatively  seldom  an 
accompaniment  of  caries,  we  shall  head  his  remarks  upon 
the  subject  with  the  name  of  that  disease,  and  arrange 
them  in  a  separate  chapter.] 


CHAPTER    FOURTH. 
[tooth-ache.] 

The  pain  commonly  termed  the  tooth-ache,  is  one  of 
the  most  excruciating  to  which  we  are  liable.  It  is 
caused  by  an  inflammation  of  the  membrane  lining  the 
cavity. 

In  inflammation,  one  of  the  usual  consequences  is  a 
swelling  of  the  part,  which  is  generally  followed  by  a 
diminution  of  the  pain,  the  degree  of  which  seems  to  be 
regulated  by  the  resistance  and  compression  which  the 
inflamed  vessels  suffer  from  the  surrounding  parts;  hence 
we  see  inflammation  of  a  part,  which  may  be  easily 
distended,  is  not  so  painful  as  that  of  one  situated  under 
a  tense  membrane,  or  fascia.  In  the  former  case,  the 
symptoms  of  general  irritation  are  scarcely  perceptible, 
whilst,  in  the  latter,  the  constitution  always  becomes  con- 
siderably affected. 

These  remarks  sufficiently  demonstrate,  that  in  conse- 
quence of  the  membrane  of  the  tooth  being  contained 
within  a  bony  cavity,  which  is  incapable  of  distension, 
there  must  necessarily  exist  an  insurmountable  obstacle 
to  the  swelling  of  the  membrane,  and  this  it  is  which  ren- 
ders the  pain  so  extremely  acute. 

In   some   few  instances,  caries  will   proceed    without 
being  accompanied  by  any  painful  sensations :  the  tooth 
gradually  breaks  away,  until  the  whole  of  it  is  removed; 
26 


198  TREATMENT    OF    TOOTH-ACHE. 

after  which,  the  gum  becomes  perfectly  smooth,  and 
appears  as  if  the  tooth  had  been  extracted.  [Its  appear- 
ance, however,  is  of  a  deeper  red;  sometimes  it  is  almost 
purple,  and  bleeds  from  the  slightest  injury.] 

Generally,  no  tooth-ache  is  experienced  until  the  caries 
has  made  some  progress.  It  is  impossible  accurately 
to  describe  an  attack  of  tooth-ache,  as  persons  are  so 
variously  affected  by  this  malady.  Some  are  suddenly 
seized  with  a  pain  darting  from  the  tooth,  through  the 
head,  so  acute  as  almost  to  induce  fainting.  A  few 
instances  of  this  mode  of  attack  I  have  witnessed  where 
the  patients  have  endured  the  pain  for  a  short  period, 
and,  alarmed  at  a  return,  have  been  so  importunate  to 
have  the  tooth  extracted,  as  scarcely  to  allow  sufficient 
time  for  preparing  the  instrument,  and,  after  the  opera- 
tion, they  have  exclaimed  that  the  pain  could  not  in  the 
least  be  compared  with  the  sufferings  attendant  upon  the 
attack. 

[Tooth-ache  is  often  induced  by  a  cold,  wrhich  causes 
inflammation  and  pain  in  the  investing  and  alveolar  mem- 
branes; in  this  case  the  teeth  are  slightly  raised  from 
their  sockets  and  exceedingly  sensitive  to  the  touch — at 
other  times  it  is  sympathetic,  being  the  result  of  disease 
in  some  other  part.  Females  during  gestation  are  very 
subject  to  it] 

[TREATMENT    OF    TOOTH-ACHE] 

More  commonly,  at  first,  the  pain  of  the  tooth-ache  is 
slight,  and  occurs  at  intervals,  being  occasioned  by  expo- 
sure to  cold,  or  the  accidental  pressure  of  some  adven- 
titious substance,  such  as  a  piece  of  crust,  the  seed  of 
some  fruit,  or  any  thing  sweet:  either  of  these  getting 
into  a  tooth,  partially  decayed,  generally  causes  some 
uneasiness.     This   kind   of  pain  may  almost  always  be 


TREATMENT    OF    TOOTH-ACHE.  199 

relieved  by  a  little  tinctura  opii,  or  it  may  subside  of  itself. 
In  either  case,  a  recurrence  may  generally  be  prevented, 
by  filling  up  the  cavity  of  the  tooth  with  some  substance 
sufficiently  hard  and  durable  to  keep  out  particles  of 
food,  and  not  liable  to  be  acted  upon  by  the  moisture  or 
heat  of  the  mouth.  [But  whenever  they  are  applied,  the 
operator  should  be  careful  not  to  touch  the  pulp  of  the 
tooth  if  it  be  exposed.] 

For  this  purpose  wax,  gum  mastic,  &c.  have  been 
employed,  but  they  are  soon  dissolved  and  destroyed, 
therefore  are  improper.  Formerly  it  was  very  much  the 
practice  to  stop  teeth  with  lead  leaf,  but  the  use  of  this 
substance  ought  to  be  forbidden,  as  it  becomes  corroded 
by  the  saliva,  and  the  introduction  of  a  very  small  quantity 
of  this  metal  into  the  body  is  found  to  be  productive  of 
deleterious  consequences :  there  is  indeed  reason  to  be- 
lieve that,  being  dissolved  by  the  menstrua  contained  in 
the  saliva,  it  may  occasion  pains  in  the  stomach,  or  other 
uneasy  sensations. 

On  this  account,  nothing  ought  to  be  used  but  what  is 
insoluble,  or,  if  soluble,  innoxious.  Gold  leaf  is  the  most 
proper  substance :  also  pure  tin,  beaten  into  leaves,  may 
be  used  with  nearly  equal  advantage :  it  is  not  so  durable 
as  the  gold,  as  the  saliva  gradually  acts  upon  it,  but  it 
cannot  do  any  injury  to  the  constitution.  [But  the 
plugging  of  a  tooth  with  a  metallic  substance  after  it  has 
ached,  is  seldom  advisable.  This  operation  has  been 
treated  of  in  another  place.] 

By  thus  excluding  the  air,  and  preventing  any  particles 
of  food  from  lodging  in  the  cavity,  the  progress  of  decay 
may  be  greatly  retarded,  the  pain  prevented,  and  the 
teeth  preserved  for  many  years. 

If  no  means  have  been  used  to  prevent  the  recurrence 
of  the  tooth-ache,  it  usually  becomes  so  violent  and  con- 


200  TREATxMENT    OF    TOOTH-ACHE. 

stant;  that  rest  is  disturbed,  and  persons  are  incapacitated 
from  pursuing  their  accustomed  avocations:  when  this 
is  the  case,  the  tooth  should  be  extracted. 

There  is  scarcely  any  thing  occasions  so  much  fear  as 
the  idea  of  the  extraction  of  a  tooth,  and  this  very  dread 
is  often  the  cause  of  most  unpleasant  consequences. 

The  inflammation  proceeds  from  the  tooth,  and  affects 
the  contiguous  parts,  the  gums  and  the  integuments  of 
the  face  swell,  and  become  much  inflamed.  The  swelling 
is  often  so  great,  that  the  mouth  cannot  be  opened,  and 
the  eye  becomes  closed:  in  other  cases,  the  swelling 
extends  down  the  neck,  and  the  constitution  is  affected 
with  the  symptoms  of  general  irritation. 

Sometimes  the  inflammation  and  swelling  will  subside^ 
and  resolution  take  place^  but  most  frequently  it  termi- 
nates in  suppuration.  Now  and  then,  after  the  matter 
has  been  discharged,  the  pain  will  cease;  but,  as  the 
diseased  tooth  remains,  the  symptoms  are  liable  to  recur 
Upon  every  exposure  to  cold.  Whenever  the  gums  are 
inflamed,  the  alveolar  processes  are  also  affected,  and 
they  are  removed  by  the  process  of  absorption.  If  a 
person  should  have  had  formation  of  matter  two  or  three 
times  about  the  fangs  of  a  tooth,  the  sockets  will  be  so 
much  absorbed  [or  rather  wasted]  that  the  tooth  will 
become  loosened:  in  this  state,  it  causes  so  much  trouble, 
that  the  patient  is  obliged  to  have  it  extracted,  and  a  cure 
is  thus  obtained. 

The  inflammation  is  sometimes  so  great  as  to  extend  to 
the  substance  of  the  jaw  bone,  and  even  to  occasion  its 
partial  mortification. 

The  distress  attending  the  process  of  exfoliation,  and 
the  consequent  deformity,  should  warn  all  persons  against 
exposing  themselves  to  the  hazard  of  such  an  occurrence. 

The  pain  proceeding    from   the    inflammation  of  the 


TREATMENT    OF   TOOTH-ACHE.  201 

membrane  of  a  carious  tooth  is  not  of  the  same  kind  in  all 
persons,  arising  probably  from  some  peculiarities  of  con- 
stitution, for  it  not  only  varies  in  its  intensity,  but  likewise 
the  sensation  excited. 

Some  describe  it  as  a  gnawing  kind  of  pain,  not 
amounting  toacuteness,  but  being  constant,  and  admitting 
of  no  continued  relief,  it  renders  them  unfit  for  either 
mental  or  bodily  exertion.  In  others,  it  comes  on  sud- 
denly, occasioning  an  acute  pain,  as  if  an  instrument  had 
been  passed  through  the  jaw:  this  occurs  at  intervals, 
and  the  expectation  of  an  attack  often  causes  as  much 
anxiety  and  distress  as  the  pain  itself.  In  others,  the 
pain  is  periodical,  there  being  an  intermission  of  some 
hours.  In  these  cases,  bark  has  been  sometimes  exhibited 
with  a  degree  of  success;  but,  at  length,  patience  being 
exhausted  by  the  continuance  of  the  pain,  extraction  of  the 
tooth  has  been  the  only  remedy.  [When  it  is  the  result 
of  a  disordered  state  of  the  stomach  an  emetic  or  cathartic 
will  often  give  relief.  When  it  occurs  during  pregnancy, 
a  dovers  powder  and  pelclilurum  on  going  to  bed  has 
been  found  beneficial.] 

The  pain  often  follows  the  course  of  the  nerves,  being 
diffused  all  over  the  cheek,  shooting  up  to  the  temple, 
and  affecting  the  head  generally. 

It  frequently  happens,  that,  when  either  of  the  dentes 
sapientiae  of  the  under  jaw  occasions  pain,  the  patient 
does  not  suffer  so  much  in  the  tooth  itself  as  in  the  ear. 

I  have  also  frequently  observed  that  the  last  tooth  of 
the  upper  jaw,  when  diseased,  has  occasioned  many 
confused  sensations,  the  pain  most  commonly  has  been 
referred  to  the  first  or  second  molares,  and  with  the 
greatest  difficulty  could  patients  be  persuaded  to  have  the 
dens  sapientiae  extracted. 

These  sympathetic  pains,  arising  from  carious  teeth, 


202  TREATMENT    OF    TOOTH-ACHE. 

proceed  from  the  intimate  connection  which  subsists 
between  the  branches  of  the  fifth  and  those  of  the  seventh 
pair  of  nerves.  The  pain  in  the  ear  is  therefore  sympa- 
thetic, arising  from  disease  in  the  dens  sapientiae;  it  is 
caused  by  a  union  of  a  branch  of  the  seventh  pair  of 
nerves  with  the  lingual  branch  of  the  fifth  pair;  this 
nervous  filament  enters  the  cavity  of  the  tympanum, 
passes  on  the  inner  side  of  the  membrana  tympani,  and  is 
called  the  corda  tympani. 

From  the  connection  which  subsists  between  these  two 
pairs  of  nerves,  it  happens  that  not  only  inflammation  in 
the  teeth  causes  a  sympathetic  pain  in  the  ears,  but  dis- 
agreeable and  unharmonious  sounds  produce  a  sympathetic 
effect  upon  the  teeth,  and  occasion  that  unpleasant  sen- 
sation called  the  teeth  being  set  on  edge. 

In  that  disease  of  the  nerves  called  tic  douloureux,  the 
teeth  are  generally  suspected  to  be  the  seat  of  the  pain. 

In  the  Medical  Records  and  Researches  is  a  very 
excellent  paper  on  this  subject,  by  Dr.  Haighton.  The 
disease  is  there  described  as  chiefly  affecting  the  fifth  and 
the  seventh  pair  of  nerves,  and  the  doctor  relates  several 
cases  of  persons,  affected  with  this  disease,  having  sub- 
mitted to  the  extraction  of  a  great  number  of  teeth,  before 
the  true  cause  of  the  pain  had  been  ascertained.  I  have 
had  the  opportunity  of  observing  a  few  of  these  cases, 
one  of  which  I  shall  relate,  on  account  of  the  remarkable 
benefit  which  followed  the  operation,  as  recommended  by 
Dr.  Haighton.  An  elderly  gentleman  applied  to  me  for 
the  purpose  of  having  some  stumps  extracted  from  the 
upper  jaw,  stating  that  he  suffered  considerable  pain  from 
them :  without  further  enquiry,  1  performed  the  operation. 
Two  days  afterwards,  he  came  to  me  again,  and  expressed 
a  wish  that  I  would  extract  the  teeth  which  were  remain- 
ing on  that  side  of  the  upper  jaw.     The  teeth  to  which 


TREATMENT    OF    TOOTH-ACHE.  203 

he  directed  my  attention  were  two  molares,  both  of 
which  appeared  to  be  perfectly  sound.  I  then  enquired 
what  his  particular  kind  of  pain  was:  he  described  it  as 
a  pain  which  had  come  on  at  intervals  for  nearly  two  or 
three  months  past ;  at  first  it  was  slight,  but  had  gradually 
arisen  to  such  a  degree  of  acuteness  as  almost  to  cause 
fainting  :  whilst  he  sat  still  he  was  easy  ;  but,  if  he  spoke 
quickly,  or  ate  any  thing  which  required  mastication,  or 
walked  hastily,  or  was  shaken  by  riding  in  a  carriage,  the 
pain  returned,  shooting  through  his  cheek,  and  affecting 
his  teeth  and  all  the  side  of  his  face,  as  if  he  had  received 
an  electric  shock.  I  had  the  opportunity  of  seeing  him 
during  two  or  three  of  these  painful  attacks.  Whilst  he 
was  relating  to  me  the  above  statement,  he  was  seized 
with  so  much  pain,  that  he  suddenly  stopped,  and  the 
water  streamed  from  his  eyes.  On  comparing  his  de- 
scription with  what  I  then  saw,  I  immediately  conceived 
that  his  complaint  was  caused  by  a  disease  of  the  sub- 
orbitar  branch  of  the  fifth  pair  of  nerves,  and  offered  to 
accompany  him  to  Mr.  Astley  Cooper,  in  orde^r  to  take 
his  opinion.  As  I  went  with  him  in  the  coach,  a  sudden 
jolt  caused  another  attack.  Mr.  Cooper,  after  having 
heard  the  above  statement,  concurred  in  the  opinion  I 
had  given,  but  was  more  particularly  confirmed  in  it  by 
producing  another  attack,  by  only  rubbing  the  hair  of  his 
beard  contrary  to  its  natural  direction. 

The  gentleman  assented  to  the  operation,  which  Mr. 
Cooper  performed  immediately.  The  nerve  was  com- 
pletely divided,  as  the  power  of  raising  that  side  of  the 
lip  ceased,  and  it  remained  as  in  a  state  of  paralysis.  The 
wound  healed  in  a  few  days,  after  which  the  pain  entirely 
left  him,  he  could  eat  with  comfort  and  take  exercise 
without  fear.  His  joy  was  so  great  at  the  deliverance 
which  he  had  experienced  from  so  much  suffering,  that 


204  TREATMENT    OF    TOOTH-ACHE. 

he  could    not  afterwards  speak  of  it  without  shedding 
tears. 

Sometimes  when  persons  suffer  extremely  with  the 
tooth-ache,  they  find  a  great  difficulty  in  fixing  upon  the 
tooth  from  which  the  pain  proceeds;  and  it  is  not  un- 
common for  them  to  refer  it  to  a  tooth  not  in  the  least 
connected  with  the  seat  of  the  disease :  frequently  they 
will  Hx  upon  a  sound  tooth,  and  it  often  happens  that  the 
pain  is  conceived  to  originate  from  a  tooth  of  the  upper 
jaw,  instead  of  one  of  the  under  jaw,  and  vice  versa. 

Whenever  any  doubt  is  expressed,  great  caution  should 
be  observed  previously  to  the  extraction  of  the  tooth. 
The  teeth  may  be  examined  by  striking  them  with  the 
end  of  a  pair  of  forceps,  in  order  to  discover  that  which 
is  the  most  tender;  as  it  usually  happens  that  a  tooth  in 
a  state  of  inflammation  is  so  sensible  that  it  will  not  bear 
to  be  struck  without  pain.  If  this  mode  of  examination 
be  not  satisfactory,  and  there  should  be  more  than  one 
carious  tooth,  they  should  be  carefully  examined  by 
picking  the  hollow  part  with  the  point  of  a  probe,  or 
other  small  pointed  instrument,  bent  in  the  form  of  a 
hook;  by  doing  this  the  exposed  nerve  of  the  tooth,  that 
has  caused  the  pain  may  be  touched,  which  will  im- 
mediately assure  the  patient  and  the  surgeon  of  the  tooth 
from  which  the  pain  proceeds.  [The  seat  of  the  disease 
may,  in  the  majority  of  cases,  be  ascertained  in  this  way, 
but  not  in  all.] 

The  means  which  have  been  employed  to  relieve  the 
pain  arising  from  inflammation  of  the  membrane  of  a  tooth, 
are  attended  with  very  different  success;  some  persons 
deriving  benefit  from  one  application,  and  others  from 
another. 

Whenever  tooth-ache  exists,  without  any  sympathetic 
affection  of  the  gums  or  socket,  those  medicines  which 


TREATMENT   OF  TOOTH-ACHE.  205 

tend  to  diminish  nervous  sensibility,  afford  relief;  opium 
conveyed  into  the  tooth,  either  in  the  form  of  tincture,  or 
solid  opium,  frequently  succeeds.  Camphor,  the  smoking 
of  tobacco,  essential  oils  of  cloves  or  of  thyme,  the  con- 
centrated acids,  &,c.  are  also  recommended,  and  with 
occasional  effect. 

It  is  most  extraordinary,  but  not  less  true,  that  there  is 
scarcely  any  pain  to  which  the  human  body  is  subject, 
that  is  so  much  under  the  influence  of  the  passions  of  fear 
or  hope,  as  the  tooth-ache;  this  is  experienced  by  almost 
every  patient,  and  as  constantly  observed  by  every  sur- 
geon, by  the  pain  generally  leaving  that  individual  who 
is  under  the  immediate  expectation  of  having  the  tooth 
extracted. 

Empirics  are  not  wanting  who  take  advantage  of  this 
circumstance,  and  pretend  to  cure  tooth-ache  by  certain 
charms  and  nostrums :  indeed,  at  the  moment  they  often 
appear  to  be  successful,  from  the  passions  of  fear  or  hope 
causing  a  temporary  suspension  of  pain. 

The  burning  of  the  antihelix  of  the  ear,  in  order  to 
relieve  this  complaint,  must  be  ranked  amongst  the  above 
methods  of  cure;  it  is  one  not  worthy  of  notice,  had  it 
not  been  formerly  a  very  popular  remedy,  and  lately  re- 
commended in  a  periodical  publication.  The  slightest 
knowledge  of  the  distribution  of  the  nerves  to  the  teeth 
must  convince  every  one,  that  a  division  of  any  part  of 
the  ear  cannot  separate  the  connection  which  subsists 
between  the  teeth  and  the  principal  branches  which  go  to 
the  brain,  and  therefore  no  more  benefit  can  be  derived 
from  this  formidable  operation,  than  may  be  attributed  to 
the  influence  of  fear. 

When  the  carious  part  of  a  tooth  is  very  sensitive  the 
pain  not  being  constant,  but  only  excited  by  some  cause 
of  irritation,  it  is  much  in  the  same  state  as  an  irritable 
27 


206  TREATMENT    OF    TOOTH- A CHE. 

ulcer,  and  the  pain  may  be  relieved  in  a  similar  manner, 
viz.  by  destroying  its  surface  with  caustic.  This  method 
of  treatment  was  first  mentioned  to  me  by  Mr.  Abernethy, 
as  one  that  he  had  tried  with  great  success,  and  which  I 
have  also  found  to  be  very  beneficial. 

The  cavity  of  the  tooth  is  first  to  be  wiped  dry  with  a 
small  piece  of  lint,  or  cotton,  then  some  lunar  caustic,  in 
solution,  may  be  introduced  on  the  point  of  a  camel's  hair 
pencil,  spreading  it  over  the  whole  of  the  carious  surface. 
This  should  be  repeated  two  or  three  times,  after  which, 
if  the  tenderness  be  removed,  the  tooth  may  be  stopped 
with  gold  leaf,  and  thus  be  preserved. 

[The  application  of  lunar  caustic  to  the  carious  part  of 
a  tooth  will  sometimes,  but  not  always,  allay  the  sensi- 
tiveness of  the  diseased  portion,  and  in  consequence  of 
the  uncertainty  of  its  effects,  its  employment  for  this 
purpose  is,  at  present,  seldom  resorted  to.] 

Attempts  have  been  sometimes  made  to  destroy  the 
nerve  with  the  actual  cautery,  by  introducing  a  red-hot 
wire;  but  I  have  scarcely  ever  found  this  plan  to  be 
effectual;  and,  as  it  always  gives  great  pain,  and  some- 
times produces  an  increase  of  inflammation,  I  think  it  is 
better  never  to  recommend  it.  Indeed,  all  applications 
are  very  uncertain,  and  therefore,  if  relief  be  not  speedily 
obtained,  it  is  advisable  to  suffer  pain  once  for  all,  by 
having  the  tooth  extracted. 

[It  was  ascertained  by  Mr.  Spooner  of  Montreal  some 
years  ago,  that  the  nerve  of  a  tooth  might  always  be 
destroyed  in  a  few  hours  by  the  application  of  a  small 
quantity  of  arseneous  acid.  This  discovery  was  pub- 
lished to  the  profession  shortly  after  by  his  brother  Dr.  S. 
Spooner  of  New  York,  in  a  popular  treatise  on  the  man- 
agement of  the  teeth.  At  first  the  discovery  promised  to 
be  of  great   value,  but   it   was   soon   ascertained,  that, 


TREATMENT    OF    TOOTH-ACHE.  207 

though  the  nerve  could  with  certainty  be  destroyed  by  it, 
and  the  tooth  afterwards  plugged,  alveolar  abscess  was 
almost  sure  to  result.  The  use  of  it  therefore,  has  been 
almost  altogether  abandoned  by  the  more  skilful  and 
experienced  of  the  profession.] 

Some  years  since  I  attempted  a  mode  of  destroying 
the  nerve,  which  at  first  promised  to  be  very  successful. 
I  knew  that  a  nerve  once  divided  did  not  re-unite  for  a 
considerable  length  of  time,  and  therefore  concluded,  that 
if  I  could  separate  the  nerve  going  into  the  tooth  from 
the  principal  branch,  that  the  pain  would  be  prevented, 
and  useful  teeth  might  be  thus  preserved. 

The  method  which  I  adopted,  was  to  raise  the  tooth, 
by  the  common  operation  of  extraction,  so  high  in  the 
socket  as  certainly  to  break  the  nerve  and  vessels  which 
enter  the  extremities  of  the  fangs;  then,  on  withdrawing 
the  force,  to  press  the  tooth  back  again  into  its  former 
situation.  I  not  only  recommended  this  operation,  but 
also  performed  it  upon  a  great  number  of  persons,  and  for 
a  short  time  nattered  myself  with  very  sanguine  expec- 
tations; these,  however,  were  quickly  destroyed,  for 
some  of  my  patients,  in  about  three  or  four  weeks  after- 
wards, came  complaining  of  pain,  and  were  anxious  to 
have  the  tooth  completely  removed.  They  did  not  suffer 
the  tooth-ache  so  acutely  as  before,  but  the  tooth  had 
become  sore,  and  was  protruded  from  the  socket,  so  that, 
whenever  the  mouth  was  closed,  the  pressure  of  the  teeth 
in  the  other  jaw  against  the  tender  one  occasioned  great 
pain. 

On  extracting  these  teeth,  I  found  the  fangs  covered 
with  a  considerable  quantity  of  coagulated  lymph;  which 
circumstance  led  me  to  believe,  that  this  operation  could 
not  be  recommended  with  any  certainty,  as  it  only  suc- 
ceeded in  those  cases  in  which  union  of  the  fangs  to  the 


208  TREATMENT    OF    TOOTH-ACHE. 

socket  took  place,  as  it  were,  by  the  first  intention;  but 
if  any  inflammation  followed,  so  as  to  produce  an  effusion 
of  lymph,  it  caused  a  thickening  of  the  periosteum,  and  a 
consequent  protrusion  of  the  tooth,  which  induced  a 
necessity  for  its  complete  removal.  Since  that  time,  I 
have  only  followed  this  practice  in  cases  where  a  tooth 
has  been  but  slightly  decayed,  and  the  patient  has  been 
very  desirous  to  suffer  any  experiment  for  its  preservation. 
In  a  great  number  of  cases  it  has  perfectly  succeeded; 
but  I  have  always  represented  the  possibility  of  its  failure. 

The  incisores  of  the  upper  jaw,  although  very  liable  to 
become  carious,  do  not  often  occasion  the  tooth-ache;  but 
when  this  is  the  case,  I  always  recommended  the  extrac- 
tion of  the  tooth  before  any  inflammation  has  affected  the 
gum;  the  decayed  part  of  the  tooth  may  then  be  removed, 
or  the  cavity  be  very  perfectly  stopped  with  gold  leaf, 
and  it  is  then  to  be  returned  into  the  socket.  The  fangs 
of  these  teeth  being  straight  and  conical,  renders  this 
operation  almost  always  successful;  the  tooth  soon  be- 
comes perfectly  fixed,  and  may  remain  many  years  useful 
for  the  articulation  of  sounds,  as  well  as  ornamental  to 
the  sight. 

[The  practice  here  recommended,  even  under  the 
most  favourable  circumstances,  is  objectionable.  A  tooth 
being  thus  deprived  of  its  vitality,  is  more  or  less  ob- 
noxious to  the  surrounding  parts.  The  removal  alto- 
gether of  the  tooth  and  the  substitution  of  an  artificial  one 
is  far  preferable.] 


CHAPTER    FIFTH. 


OF    EXTRACTION    OF    THE    TEETH. 


Few  operations  in  the  ordinary  practice  of  medical 
men,  are  more  repugnant  to  their  own  feelings,  as  well 
as  to  those  of  their  patients,  than  the  extraction  of  a  tooth. 
In  this  operation,  both  surgeon  and  patient  are  frequently 
alike  influenced,  as  it  often  happens  that  the  former  is 
quite  as  much  averse  from  performing  the  operation,  as 
the  latter  is  from  suffering  it.  This  reluctance  in  the 
surgeon  can  only  arise  from  deficiency  of  confidence  in 
his  own  abilities,  producing  fear  lest  he  should  perform 
the  operation  unsuccessfully.  I  shall,  therefore,  offer  a 
few  hints,  which  may  tend  to  remove  distrust,  and,  in 
this  way,  increase  the  fortitude  of  a  timid  operator. 

The  various  conditions  of  the  teeth,  which  may  create 
necessity  for  their  extraction,  produce  equally  great  va- 
riety in  the  difficulty  or  ease  with  which  the  operation 
may  be  performed.  In  some,  the  teeth  are  so  loose,  that 
they  may  almost  be  taken  away  by  the  fingers;  in  others 
from  the  carious  state  of  the  teeth,  or  from  the  direction 
and  strength  of  the  fangs,  it  is  impossible  to  succeed, 
notwithstanding  the  greatest  care  or  ability.  [This,  no 
doubt  was  true,  at  the  time  of  the  publication  of  the  first 
edition  of  this  work,  but  it  is  not  at  present.  Any  tooth 
may  now,  with  proper  instruments,  be  removed,  with 
safety,  by  a  skilful  operator.] 


210  THE    KEY    INSTRUMENT. 

Extraction  of  the  teeth  is  required  for  the  following 
reasons:  in  children,  to  prevent  or  remedy  irregularity 
in  the  arrangement  of  the  permanent  teeth,  and  on  ac- 
count of  tooth-ache  arising  from  caries  of  the  molares, 
which  is  a  very  common  circumstance.  In  adults,  from 
the  teeth  having  become  loosened  from  an  absorption  of 
the  alveolar  processes ;  or  from  some  other  cause,  as  the 
effects  of  caries. 


[INSTRUMENTS  EMPLOYED  IN  THE   OPERATION.] 

It  would  be  useless  to  mention  the  great  variety  of 
forms  in  which  instruments  for  extracting  the  teeth  have 
been  made :  I  shall  only  describe  such  as  are  really  use- 
ful, and  make  a  few  remarks  on  some  that  have  been 
strongly  recommended. 

[THE  KEY  INSTRUMENT.] 

The  key  instrument,  or,  as  it  has  been  commonly 
called,  the  German  key,  is  the  most  useful :  it  has  under- 
gone several  alterations  in  form,  and  has  received  some 
improvements,  which,  I  think,  have  brought  it  as  near  to 
perfection  as  possible.  The  first  material  improvement 
in  this  instrument  wTas  made  by  Mr.  Spence :  it  consisted 
in  adding  a  projecting  part  at  the  end  of  the  bolster, 
through  which  the  screw  is  passed.  This  addition  was 
made  for  the  purpose  of  fixing  a  claw,  in  an  advanced 
position,  beyond  the  bolster,  which  was  found  extremely 
useful  in  the  extraction  of  the  dentes  sapientiae. 

Mr.  Savigny  introduced  his  improved  key  with  a 
round  bolster,  and  a  raised  form  in  the  stem  of  the  in- 
strument, which  is  very  convenient  for  avoiding  injury  to 
the.  front   teeth,  when  it  may  be  required  to  extract  a 


THE    KEY    INSTRUMENT.  211 

tooth,  by  fixing  the  bolster  on  the  inner  side  of  the  jaw. 
It  occurred  to  me  that  another  addition  was  still  requisite 
to  make  it  complete,  and  that  was,  to  be  able  to  fix  a 
claw  behind  the  bolster,  that  it  might  act  on  a  principle 
similar  to  Mr.  Spence's  improvement,  which  is,  to  have 
the  fulcrum  of  the  instrument  applied  at  a  different  place 
from  the  carious  tooth  to  be  extracted.  In  Mr.  Spence's 
instrument,  the  claw  is  placed  before  the  fulcrum,  in 
mine,  the  fulcrum  is  placed  before  the  claw.  This  im- 
provement I  have  found  of  very  essential  service  in  ex- 
tracting the  bicuspides  of  the  lower  jaw,  and  also  in  cases 
where  a  large  gum-boil,  of  extreme  sensibility,  happened 
to  be  situated  at  the  part  where  the  fulcrum  of  the  com- 
mon instrument  would  have  been  placed;  a  circumstance 
of  great  utility,  as  the  pressure  may  be  made  upon  an 
insensible,  rather  than  upon  an  inflamed  part.  The  de- 
scriptions in  Plate  XXII.  will  clearly  illustrate  the  above 
statement.  The  alterations  in  this  instrument,  from  Mr. 
Savigny's  improved  key,  which  had  the  advantage  of 
Mr.  Spence's  improvement,  consist  in  a  place  for  fixing 
the  claw  behind  the  fulcrum,  and  in  having  the  bolster  of 
an  oval  form  instead  of  a  round  one,  as  the  latter  occupies 
too  much  room  in  the  mouth.  This  instrument  is  appli- 
cable to  the  extraction  of  the  bicuspides  and  molares. 

For  the  removal  of  the  molares  of  children,  a  small 
spring  key  instrument  is  very  requisite.  In  operating 
upon  a  child,  nothing  ought  to  be  exhibited  that  might 
occasion  alarm :  a  very  small  instrument  may  be  hidden 
in  the  hand,  which,  by  preventing  terror  in  the  child, 
will  produce  submission  to  the  operation :  this  small  key 
instrument  may  be  accommodated  to  the  handle  of  the 
large  one. 

Sometimes  it  happens  that  a  molaris  on  each  side  of 
the  mouth  occasions  tooth-ache  at  the  same  moment,  in 


212  THE    PACES. 

which  case,  it  is  desirable  to  remove  both  of  them ;  but 
there  is  great  difficulty,  after  a  child  has  felt  the  pain 
from  the  extraction  of  one  tooth,  to  persuade  it  to  submit 
to  a  second  operation ;  on  this  account  we  must  always 
endeavour  to  be  as  quick  as  possible.  It  is  very  easy, 
when  the  mouth  is  open,  to  extract  more  than  one  tooth, 
as  the  claw  of  a  spring  key  can  be  turned  in  so  short  a 
time  that  the  little  patient  scarcely  knows  any  thing  about 
it.  Parents  are  too  solicitous  to  prepare  the  minds  of 
their  children  for  undergoing  the  extraction  of  a  tooth,  by 
talking  of  it,  and  assuring  them  that  they  will  not  be  hurt, 
&,c.  &c.  but  I  have  usually  observed  that  attempts  of  this 
kind  are  often  unsuccessful,  and  the  contrary  disposition 
is  more  generally  excited.  The  best  plan  is  not  to  men- 
tion to  the  child  any  intention  of  having  its  tooth  extracted, ' 
but  only  to  allow  the  time  for  performing  the  operation 
to  be  the  moment  of  deliberation.  Children  are  often 
tortured  with  the  anticipation  for  several  days  together, 
and,  when  the  moment  arrives,  they  have  lost  all  their 
fortitude. 

THE   PACES. 

For  the  extraction  of  the  incisores  in  the  adult,  and 
the  incisores  and  loose  molares  in  children,  an  instru- 
ment is  used,  called  the  paces:  this  instrument  is  an 
improvement  upon  the  crowVbill,  formerly  used.  The 
form  recommended  by  Dr.  Blake,  of  Dublin,  is  the  best; 
they  are  made  straight  and  curved.  The  instrument  for 
adult  teeth  should  be  larger  and  stronger  than  that  for 
the  temporary  teeth.  For  the  extraction  of  a  stump,  the 
instrument  commonly  called  a  punch  is  employed.  Be- 
sides these  instruments,  a  pair  of  forceps,  like  the  common 
dressing  forceps,  but  rather  stronger,  are  required  for  the 
purpose  of  removing  a  loosened  stump,  or  any  small 
splinter. 


OF    THE    FORCEPS.  213 

THE    PERPENDICULAR   EXTRACTOR. 

Some  persons  have  very  strongly  recommended  instru- 
ments adapted  for  the  perpendicular  extraction  of  teeth  : 
much  ingenuity,  indeed,  has  been  exercised  in  the  con- 
struction of  all  these;  but  they  are  not  applicable  to 
general  use.  The  principle  on  which  they  all  act  is  this; 
that,  after  having  fixed  the  extracting  instrument  on  the 
carious  tooth,  a  powerful  action  is  made  with  it,  and  the 
tooth  is  removed,  just  on  the  same  principle  as  that  by 
which  a  cork  is  drawn  from  a  bottle  by  the  patent  cork- 
screw. There  are  several  insurmountable  objections  to 
this  mode  of  extraction :  in  the  first  place,  the  instruments 
being  of  complicated  structure,  they  cannot  be  used 
quickly,  a  circumstance  of  the  greatest  importance:  sec- 
ondly, it  not  unfrequently  happens  that  the  tooth  to  be 
extracted  is  much  stronger  than  the  tooth  on  which  the 
counter  pressure  is  to  be  made;  here  the  sound  tooth  is 
much  injured,  and  the  carious  one  cannot  be  extracted: 
thirdly,  the  fangs  of  some  teeth  being  very  divergent,  it 
is  not  possible  to  extract  them  in  a  perpendicular  direc- 
tion, any  more  than  a  piece  of  wood,  dove-tailed  in  a 
mortise,  can  be  removed  in  any  other  way  than  in  a 
lateral  direction :  fourthly,  there  may  be  no  teeth  remain- 
ing on  which  the  counter  pressure  can  be  made.  In 
trying  these  instruments,  I  have  met  with  all  these  various 
difficulties,  and,  therefore,  think  them  inapplicable  to 
general  use. 

[OF  THE  FORCEPS.] 

[It  is  not  surprising  that  the  author  should  have  given 
a  decided  preference  to  the  key  instrument,  for,  during 
his  time,  the  forceps  employed  for  the  extraction  of  teeth, 
were  so  awkward  in  their  construction  and  illy  adapted 

28 


214  OF    THE    FORCEPS. 

to  the  operation,  as  to  render  them  not  only  inefficient  in 
their  use,  but  also  inconvenient  in  their  application.  But 
the  objections  to  their  use,  that  existed  at  that  time, 
cannot  now  be  urged.  They  have  been  so  improved 
during  the  last  twelve  or  fifteen  years,  that,  at  present, 
they  are  the  safest,  most  convenient,  and  efficient  instru- 
ments that  can  be  employed.  Any  tooth  that  can  be 
removed  with  the  key,  can  be  extracted  with  a  properly 
constructed  pair  of  forceps,  and  in  the  majority  of  cases 
with  greater  ease  and  convenience  to  the  operator,  and 
less  pain  and  injury  to  the  patient;  besides,  many  teeth 
which  cannot  be  removed  with  that  instrument  can  be 
extracted  with  ease  and  safety  with  these. 

In  discussing  the  relative  merits  of  the  key  instrument 
and  forceps,  the  editor  can  speak  advisedly  upon  the 
subject,  having  used  both  for  many  years,  the  former  for 
more  than  eight  and  the  latter  for  about  twelve  years. 
He  is  happy  too,  to  believe,  that  in  giving  his  preference 
to  properly  constructed  forceps,  he  expresses  the  opinion 
of  all  who  have  given  both  instruments  a  fair  trial.  There 
may  be  some,  who,  having  been  accustomed  to  the  use  of 
the  key  instrument  for  many  years, — have  only  occasion- 
ally employed  forceps,  and  which  perhaps  were  not  of  the 
best  construction,  still  persist  in  giving  a  preference  to 
that  instrument.  But  this  constitutes  no  argument  what- 
ever in  its  favour.  To  form  a  correct  opinion  of  the 
relative  merits  of  the  two  instruments,  it  is  necessary  to 
use  each  for  a  length  of  time,  say  three  or  four  months, 
to  the  entire  exclusion  of  the  other.  All  who  have  done 
this,  give  a  decided  preference  to  the  forceps.  The 
author  himself  acknowledges  that  frequent  injuries  to 
the  alveoli  are  unavoidable  in  the  use  of  the  key,  which, 
with  forceps  properly  adapted  to  the  operation,  need 
seldom  if  ever  be  inflicted. 


INCISOR    FORCEPS.  215 

But  notwithstanding  the  great  improvements  which 
have  been  made  in  the  shape  and  form  of  forceps,  not 
one  dentist  in  five,  of  those  who  use  them,  have  such  as 
are  best  suited  to  the  operation.  Many  too,  have  four 
times  as  many  as  are  really  requisite,  believing  from  their 
number,  they  will  always  be  able  to  select  one,  adapted 
to  the  peculiarity  of  any  case  which  may  come  up  in 
their  practice,  seemingly  ignorant  of  the  fact,  that  effi- 
ciency of  their  action  depends  more  on  their  shape  and 
construction  than  on  their  multiplicity.  Seven  pair  are 
all  that  are  required  for  the  operation.  The  beak  of  each 
of  these  should  be  so  adapted  to  the  necks  of  the  teeth  to 
which  it  is  intended  to  be  applied,  as  to  secure  a  firm  hold  ; 
the  handles  should  be  no  longer  than  is  absolutely  neces- 
sary to  accommodate  the  hand  of  the  operator,  to  which, 
they  should  be  accurately  fitted  and  so  bent  as  not  to 
interfere  with  the  teeth  in  the  opposite  jaw.  But  in 
describing  them,  it  will  be  better  to  do  it,  under  the 
names  of  the  teeth,  intended  to  be  extracted  by  each.  I 
will  commence  with  those  to  be  used  on  the  teeth  in  the 
upper  jaw. 

FORCEPS    FOR    THE    EXTRACTION    OF    THE    SUPERIOR    INCISOR 
AND   CUSPIDATI. 

For  the  extraction  of  the  upper  incisores  and  cuspidati, 
but  one  pair  of  forceps  is  required.  These  should  be 
straight,  with  the  nibs  of  their  beak  hollowed  out  on  the 
inside  so  as  not  to  press  upon  the  crown  of  the  tooth 
during  the  operation.  The  extremity  of  each  nib,  too, 
should  be  sufficiently  hollowed  on  the  inside  to  fit  the 
neck  of  an  incisor  or  cuspidati  tooth.  They  should  also 
be  slightly  notched  to  prevent  them  from  turning  on  it, 
when  a  rotary  motion  is  given  to  the  instrument:  the 


216  UPPER    MOLAR    FORCEPS. 

handles  should  be  broad  and  about  five  or  five  and  a  half 
inches  in  length;  one  should  be  bent  near  the  end  so  as 
to  form  a  hook  to  pass  round  the  little  finger  of  the  hand 
of  the  operator.  The  extremities  of  the  beak  should  be 
thin,  in  order  to  admit  of  being  forced  high  up  on  the 
tooth  under  the  gums.  But  a  better  idea  may  be  formed 
of  the  instrument  by  an  examination  of  Fig.  1,  Plate 
XXIV.  where  it  is  represented.  These  forceps,  besides 
being  specially  adapted  to  the  extraction  of  the  superior 
incisores  and  cuspidati,  are  in  many  cases  the  best  that 
can  be  employed  for  the  removal  of  the  upper  bicuspides. 

FORCEPS  FOR  THE  EXTRACTION  OF   THE  SUPERIOR  MOLARES. 

The  above  named  teeth,  having  three  roots  each,  two 
outer  and  one  inner,  require  for  their  removal  two  pair 
of  forceps,  one  for  the  right  and  one  for  the  left  side  of 
the  mouth.  The  beaks  of  these  forceps  should  be  bent 
sufficiently  to  clear  the  tooth,  anterior  to  the  one  on  which 
it  is  to  be  applied  without  depressing  the  handles  so  much 
as  to  throw  them  in  contact  with  the  teeth  in  the  lower 
jaw.  The  outer  nib  of  the  beak  of  each  pair,  should 
have  two  grooves  filed  in  its  extremity,  with  a  fine  point 
between  them,  to  fit  in  the  depression  on  the  side  of  the 
neck  of  the  tooth,  just  below  the  bifurcation  of  its  outer 
roots.  The  inner  nib  or  blade,  should  be  grooved  to  fit 
the  neck  of  the  tooth  on  the  palatine  side.  The  handles 
should  be  broad  and  strong  enough  to  prevent  them  from 
springing  under  the  grasp  of  the  hand  of  the  operator. 
The  handle  of  each  instrument  toward  the  operator, 
when  applied  to  the  tooth,  should  have  a  hook  on  the 
end  of  it  to  pass  round  the  little  finger,  in  order  to  pre- 
vent it  from  slipping  in  the  hand  when  it  is  moist  with 
perspiration.     These  forceps  are  represented  in  Figs.  2 


BICUSPID    AND    DENTES    SAPIENTIjE    FORCEPS.    217 

and  3,  Plate  XXV.     Their  handles  should  be  about  the 
length  of  the  incisor  and  cuspidati  forceps. 

FORCEPS    FOR    THE    EXTRACTION    OF    THE    SUPERIOR    DENTES 

SAPIENTLE. 

Although  in  most  cases,  the  forceps  to  be  hereafter 
described  for  the  extraction  of  the  bicuspides  of  both  jaws 
and  the  cuspidati  of  the  lower,  are  the  most  convenient 
and  best  instrument  that  can  be  used  for  the  removal  of 
the  superior  dentes  sapientiae:  it  sometimes  happens,  that 
one  of  a  different  shape  is  necessary,  these  should  be 
bent  in  the  beak  above  the  joint  so  as  to  form  two  right 
angles.  The  object  of  this  is  to  clear  the  second  molaris, 
when  the  dens-sapientiae  is  considerably  shorter  than  this 
tooth.  Each  blade  or  nib  of  the  beak  of  these  forceps, 
should  be  grooved  on  the  inside,  to  make  them  fit  the 
necks  of  these  teeth.  The  handles  should  be  broad  and 
one  bent  at  the  end  in  the  manner  as  before  described. 

These  forceps  are  also  useful  for  the  extraction  of  the 
root  of  a  tooth  situated  close  behind  another  tooth.  Fig. 
4,  Plate  XXIV.  is  an  accurate  representation  of  them. 

FORCEPS  FOR  THE  EXTRACTION   OF  THE  BICUSPIDES  OF   BOTH 
JAWS   AND  THE   INFERIOR  CUSPIDATI  AND  DENTES  SAPIENTIJE. 

But  one  pair  of  forceps  are  required  for  the  extraction 
of  these  teeth.  The  handles  of  these  should  be  straight 
and  broad,  without  a  hook  on  either.  Each  nib  should 
be  grooved  on  the  inside,  and  both  bent  so  as  to  form 
an  angle  of  twenty-five  or  thirty  degrees  with  the  han- 
dles. They  should  also  be  narrow  to  prevent  interfering 
with  the  adjoining  teeth,  and  thin  so  as  to  admit  of  being 
slipped  under  the  gums  to  the  e(\^e   of  the   alveolus. 


218  INFERIOR    MOLAR    FORCEPS. 

With  a  forcep  of  this  description,  a  bicuspis  in  either 
jaw  can  readily  be  extracted.  They  are  also  better  suited 
to  the  extraction  of  the  inferior  cuspidati  and  dentes 
sapiential  than  any  other  instrument.  In  the  majority  of 
cases  too,  they  are  the  best  for  the  removal  of  the  upper 
dentes  sapientiae.  These  forceps  are  represented  in 
Fig.  2,  Plate  XXIV. 

FORCEPS  FOR  THE  EXTRACTION  OF  THE   INFERIOR  INCISORES. 

The  only  difference  between  the  forceps  now  under 
consideration  and  those  last  described,  is,  that  the  beak 
of  the  latter  should  not  be  more  than  one-third  the  width 
of  those  of  the  former.  The  handles  should  be  of  the 
same  width  and  length,  and  the  beak  have  the  same  cur- 
vature. And  while  forceps  of  this  description  are  admi- 
rably adapted  to  the  extraction  of  the  lower  incisores, 
they  are  the  most  efficient  instrument  that  can  be  em- 
ployed for  the  removal  of  the  roots  of  the  bicuspides  and 
molares,  for  it  often  happens  that  the  former  are  so  much 
funneled  out  by  caries  as  to  prevent  their  walls  from 
affording  a  sufficiently  firm  support  to  any  other  forceps 
for  their  extraction.  But  with  these  a  portion  of  the 
alveolus  may  be  included  between  the  nibs,  and  cut 
through  and  the  root  grasped  and  removed  at  once. 
This,  therefore,  may  be  regarded  as  one  of  the  most 
valuable  extracting  instruments  that  has  ever  been  em- 
ployed.   A  view  of  it  is  exhibited  in  Fig.  4,  Plate  XXV. 

FORCEPS  FOR  THE  EXTRACTION  OF  THE   INFERIOR  MOLARES. 

The  lower  molares  having  two  roots,  one  anterior  and 
one  posterior,  require  for  their  removal,  forceps  of  a 
different  construction  from  any  which  have  yet  been  de- 


MANNER    OF    EXTRACTING    TEETH.  219 

scribed.  Each  blade  or  nib  of  the  beak  should  have  two 
grooves  with  a  point  in  the  centre,  so  constructed  as  to 
fit  the  depression  on  each  side,  just  above  the  bifurcation 
of  the  roots.  The  beak  should  be  curved  just  enough  to 
make  the  instrument  clear  the  tooth  immediately  before 
the  one  to  which  the  instrument  is  applied.  Mr.  Snell, 
the  inventor  of  the  beak  of  these  forceps,  as  well  as  those 
for  the  extraction  of  the  upper  molares,  employs  two  pair 
for  the  removal  of  the  teeth  in  question.  But  by  an 
improvement  made  by  the  editor,  one  pair  will  answer 
the  purpose  better  than  two.  The  improvement  consists 
in  having  the  handles  bent  so  that  the  instrument  may  be 
applied  with  equal  convenience  to  a  tooth  on  either  side 
of  the  mouth,  while  the  operator  always  occupies  the 
same  position  and  has  his  left  arm  and  hand  to  control  his 
patient's  head  and  lower  jaw,  which  he  can  do  better 
than  any  assistant.  But  a  better  idea  may  be  formed  of 
the  shape  and  peculiar  construction  of  these  forceps,  as 
improved  by  the  editor,  from  an  examination  of  Fig.  1, 
Plate  XXV.  than  from  any  description  which  can  be 
given  of  them.  The  handles  it  will  be  perceived  are  bent 
towards  the  operator,  with  a  hook  on  the  inner  one,  to 
pass  round  the  little  finger  like  some  of  the  others  which 
have  been  before  described. 

The  manner  of  using  these  forceps  will  be  described  in 
connection  with  the  parts  of  the  work  which  treats  on  the 
extraction  of  the  different  classes  of  teeth.] 

[MANNER  OF  EXTRACTING  TEETH.] 

I  shall  now  state  the  manner  of  extracting  the  different 
classes  of  teeth,  accompanied  with  cautions  necessary  to 
be  observed  under  different  circumstances. 

Previously  to    the  extraction   of  a   tooth,  it   is   very 


220        EXTRACTION  OF  INCISORES  AND  CUSPIDATI. 

necessary  that  the  gum  should  be  separated  as  much  as 
possible  from  the  neck  of  the  tooth  and  the  edges  of  the 
alveolar  processes.  This  is  to  be  done  with  a  gum  lancet, 
and  a  round  edged  one  is  to  be  preferred  to  a  pointed 
one.  The  lancing  the  gum  saves  it  from  being  torn  by 
the  raising  of  the  tooth,  and  the  claw  of  the  instrument 
can  be  pushed  so  much  under  the  gum  as  to  obtain  a 
firmer  hold  upon  the  neck  of  the  tooth.  In  young  chil- 
dren, we  may  dispense  with  the  lancing  of  the  gum,  on 
account  of  their  extreme  timidity;  beside,  as  their  teeth 
are  commonly  not  very  strong  in  the  sockets,  there  is 
very  little  danger  of  injuring  the  gums. 

[DIRECTIONS    FOR  THE    EXTRACTION  OF  THE    INCISORES    AND 

CUSPIDATI.] 

The  incisores  and  cuspidati,  although  very  subject  to 
caries,  are  not  frequently  affected  with  tooth-ache,  there- 
fore it  is  not  often  required  to  extract  them  on  that 
account.  In  the  loose  state,  they  are  easily  removed, 
and  the  paces  have  commonly  been  used ;  but,  when  firm 
in  the  head,  it  has  been  usual  to  employ  the  key  instru- 
ment. There  are  two  or  three  objections,  however,  to 
this  practice:  it  must  be  recollected  that  the  fangs  of 
these  teeth  are  long,  and  the  alveolar  processes  thin ;  it 
is,  therefore,  almost  impossible  to  extract  an  incisor  or 
a  cuspidatus  with  a  key  instrument,  without  splitting  up 
the  alveolar  processes.  This  accident,  together  with  the 
unavoidable  contusion  of  the  gum,  occasioned  by  the 
pressure  of  the  instrument,  leaves  an  unpleasant  ulcer, 
which,  being  in  the  front  of  the  mouth,  is  very  percep- 
tible, and  as  it  is  a  considerable  time  in  healing,  the 
patient  often  expresses  much  dissatisfaction;  there  is  also 
a  danger  of  breaking  the  tooth  in  the  middle  of  the  fang, 


EXTRACTION   OF  INCISORES   AND  CUSPIDATI.       221 

especially  in  the  case  of  the  cuspidati.  These  accidents 
are  avoided  by  making  use  of  the  paces;  and,  as  these 
teeth  are  straight,  and  have  conical  fangs,  they  may  be 
extracted  in  the  direction  of  the  socket,  which  will  pre- 
vent its  fracture,  as  well  as  the  contusion  of  the  gum. 

The  manner  of  using  the  paces  is  this:  the  tooth  is  to 
be  laid  hold  of,  upon  the  fang,  as  far  as  possible  under 
the  gum.  The  instrument  is  then  to  be  grasped  with  a 
force  just  sufficient  to  hold  the  tooth  tight,  but  not  to 
pinch  so  hard  as  to  crush  it.  The  attachment  of  the 
periosteum  of  the  fang  to  that  of  the  socket  is  then  to  be 
separated  by  moving  the  tooth  from  side  to  side,  by  a 
gentle  but  steady  motion  of  the  wrist.  When  the  tooth 
has  thus  been  moved  in  its  socket,  it  may  be  drawn 
straight  out.  Sometimes  it  will  be  requisite  to  use  efforts 
for  some  time  to  loosen  the  tooth ;  for  it  must  be  remarked, 
that  scarcely  any  man  has  sufficient  strength  to  extract 
one  of  these  teeth  by  direct  force;  but  if  a  tooth  be  first 
loosened  in  the  socket,  by  moving  it  from  side  to  side,  it 
may  then  be  extracted  successfully.  The  teeth  of  chil- 
dren are  always  removed  with  facility;  the  only  impedi- 
ment being  the  resistance  induced  by  their  fears. 

[It  is  not  to  be  wondered  that  the  extraction  of  the 
incisores  should  have  been  regarded  both  as  a  difficult 
and  rather  dangerous  operation,  when  for  the  want  of  a 
more  suitable  instrument,  it  often  became  necessary  to 
have  recourse  to  the  key  for  their  removal.  The  injuries 
of  which  the  author  speaks,  as  being,  in  many  cases 
unavoidable,  need  never  be  inflicted  in  the  extraction  of 
these  teeth.  With  forceps  such  as  have  been  described 
by  the  editor,  they  can  always  be  removed  with  both 
ease  to  the  operator  and  safety  to  the  patient. 

For  the  extraction  of  an  upper  incisor  or  cuspidatus, 
the  forceps  first  described  and  represented  in  Fig.  1. 
29 


222  EXTRACTION    OF    THE 

Plate  XXIV.  should  be  employed.  With  these,  after 
having  separated  the  gum  from  the  neck  of  the  tooth,  it 
should  be  grasped  as  high  up  as  possible,  and  just  tight 
enough  to  prevent  the  instrument  from  slipping.  This 
done,  it  should  be  moved  several  times  in  quick  succes- 
sion, backwards  and  forwards,  and  then  with  a  rotary  mo- 
tion, the  tooth  may  be  pulled  from  the  socket.  The  root 
of  an  upper  cuspidatus  being  rather  more  flattened  than 
that  of  an  incisor,  will  not  admit  of  as  much  rotary  mo- 
tion, in  its  extraction.  This,  the  operator  should  bear  in 
mind  in  the  removal  of  these  teeth.  It  is  also  longer, 
and  oftentimes  requires  considerable  more  force  for  its 
removal. 

The  lower  incisores  are  generally  less  firmly  articulated 
than  the  upper,  and  as  might  readily  be  supposed,  are,  in 
the  majority  of  cases,  more  easily  removed.  The  forceps 
represented  in  Fig.  4,  Plate  XXV.  should  be  employed 
for  their  extraction.  They  should  be  applied  as  low  down 
on  the  neck  of  the  tooth  as  possible,  and  after  moving  it 
several  times  backwards  and  forwards,  giving  at  the  same 
time,  a  slight  rotary  movement  to  the  instrument,  it  should 
be  raised  from  the  socket.  When  the  tooth  to  be  extrac- 
ted is  situated  behind  the  arch,  as  is  often  the  case,  a 
rotary  motion  only  should  be  given  to  the  instrument, 
previously  to  the  removal  of  the  organ. 

The  inferior  cuspidati  may  also  be  removed  with  the 
forceps  recommended  for  the  extraction  of  the  lower 
incisores,  but  it  is  better  to  use  a  pair  having  wider 
beaks.] 

[DIRECTIONS  FOR  THE  EXTRACTION  OF  THE  BICUSPIDES  AND 

MOLARES.] 

The  biscuspides  and  molares  should  be  extracted  with 
the  key  instrument  which  must  be  always  furnished  with 


BICUSPIDES    AND    MOLARES.  223 

three  claws,  adapted  to  the  different  sizes  of  the  crowns 
of  the  teeth.  The  smallest  claw  is  designed  for  the  bi- 
cuspides; the  next  in  size  for  the  molares  of  the  under 
jaw,  and  the  dentes  sapientise  of  the  upper  jaw ;  and  the 
largest  size  for  the  first  and  second  molares  of  the  upper 
jaw.  The  bicuspides  of  the  upper  jaw  may  be  extracted 
with  the  claw  placed  in  the  usual  mode,  as  little  difficulty 
attends  their  removal;  but  the  bicuspides  of  the  lower  jaw 
being  very  long  and  slender,  the  fangs  are  liable  to  be 
broken  off  at  about  two-thirds  of  their  length,  leaving  a 
piece  in  the  socket;  this  circumstance  arises  from  the 
pressure  of  the  bolster  of  the  instrument  against  the  exte- 
rior part  of  the  middle  of  the  fang,  and  the  resistance  to 
the  extraction  of  the  fang  made  by  the  inner  and  lower 
part  of  the  socket. 

These  accidents  are  certainly  avoided  by  fixing  the 
claw  behind  the  bolster,  as  in  Fig.  8,  Plate  XXII.  and  in 
Plate  XXIII.  Fig.  2.  The  instrument,  in  this  way,  acts 
upon  the  tooth  only  in  the  place  were  the  claw  is  fixed, 
and,  by  the  fulcrum  being  applied  beyond  the  tooth,  no 
resistance  is  made  against  the  side  of  the  alveolus;  thus 
the  tooth  is  usually  extracted  perfectly  whole,  and  with 
great  ease. 

The  molares  are  extracted  with  claws  proportioned  to 
their  size,  which  are  to  be  fixed  even  with  the  bolster.* 

Much  diversity  of  opinion  has  existed  as  to  the  precise 
direction  in  which  the  teeth  should  be  drawn:  it  has  been 
recommended  by  some,  to  draw  the  second  and  third 
molares  of  the  under  jaw  inwardly,  and  all  the  others  out- 
wardly. The  reason  assigned  for  this  rule  is,  that  those 
teeth  naturally  incline  inwardly,  and  the  alveolar  proces- 
ses, being  thin  on  that  side,  yield  with  greater  ease,  by 
which  the  extraction  of  the  tooth  is  facilitated. 

*  Plato  XXII.  Fig.  7,  and  Plate  XXIII.  Fig.  & 


224  extka(Tio.\  or  Tin: 

From  much  experience,  however,  I  have  found  that 
this  plan  cannot  be  practised  without  incurring  difficulty 
and  danger;  when  these  teeth  incline  much  inwards,  they 
are  situated  out  of  the  perpendicular  with  respect  to  the 
jaw,  and  hang  considerably  over  the  base.  When  the 
instrument  is  fixed,  the  claw  taking  hold  of  the  tooth  at 
the  outer  side,  the  bolster  presses  upon  the  jaw  in  a  part 
relative  to  the  tooth,  in  a  line  so  much  out  of  the  perpen- 
dicular, that  the  force  applied  acts  upon  the  tooth  in  a 
diagonal  line  from  the  outer  part,  at  the  neck,  to  about 
the  middle  of  the  inner  part  of  the  fangs :  hence  there  is 
great  danger,  if  the  fangs  are  very  strong,  that  the  tooth 
will  be  broken  off,  and  leave  a  part  of  the  fangs  in  the 
socket.  There  is  also  danger  lest  the  extraction  of  the 
tooth  should  be  attended  with  a  fracture  of  the  alveolar 
processes,  for  it  is  very  liable  to  extend  considerably.* 

Much  soreness  is  likewise  occasioned  by  the  pressure 
of  the  instrument  against  the  soft  parts  under  the  side  of 
the  tongue,  which  causes  a  swelling  and  a  tenderness  that 
continue  for  some  time.  Extraction,  in  this  manner,  is 
frequently  rendered  impracticable,  by  the  caries  being 
situated  at  the  side  where  the  claw  should  be  fixed:  this 
is  very  commonly  the  case  with  the  dentes  sapientiae, 
wThich  would  render  the  removal  of  these  teeth  an  impos- 
sibility, without  using  the  instrument  according  to  Mr. 
Spence's  improvement.!  For  these  reasons,  a  general 
rule  may  be  given,  that  the  key  instrument  should  ahvays 
be  applied  in  such  a  manner,  as  to  extract  the  tooth  out- 
wardly, except  in  those  cases  where  the  state  of  the  decay 
renders  it  impossible. 

The  extraction  of  the  dentes  sapientiae  of  the  under 
jaw  is  attended  with  more  difficulty  than  that  of  any  other 
of  the  teeth.     The  jawT-bone  begins  to  rise  on  the  outer 

*  Plate  XXIII.  Fi?.  5.  \  Plate  XXII.  Fi?.  <i. 


BICUSPIDES    AND    MOLARES.  225 

side  of  the  dentes  sapiential,  in  order  to  form  the  coronoid 
process;  and,  in  some  persons,  the  rise  of  the  bone  is 
nearly  as  high  as  the  tooth.  Hence  there  is  not  sufficient 
depth  for  the  bolster  of  the  instrument  to  be  applied  on 
the  outside  of  the  tooth,  and  there  would  always  be  a 
necessity  for  drawing  the  tooth  inwardly,  if  we  did  not 
possess  a  safe  method  of  extracting  it  outwardly.  It  was 
with  this  view  that  the  improvement  of  Mr.  Spence  was 
introduced.  A  dens  sapiential  which  is  much  decayed 
on  the  outer  side,  could  not  be  drawn  inwardly,  because 
the  decayed  state  of  the  tooth  would  prevent  proper  hold 
for  the  instrument.  Likewise,  with  a  common  key  in- 
strument, it  would  not  be  possible  to  draw  it  outwardly, 
because  the  rise  of  the  jaw-bone  would  render  it  imprac- 
ticable. These  difficulties  are  entirely  obviated  by 
advancing  the  claw  beyond  the  bolster;  a  fulcrum  is  then 
conveniently  obtained  by  applying  the  bolster  upon  the 
jaw  at  the  outer  side  of  the  second  molaris,  and  the  claw 
being  fixed  on  the  inner  side  of  the  tooth,  it  may  be 
drawn  outwardly  with  great  safety.  By  operating  in 
this  manner,  much  difficulty  is  obviated,  and  the  danger  of 
breaking  away  large  portions  of  the  alveolar  processes  is 
prevented.* 

[The  bicuspides  and  molares,  as  has  been  before  stated, 
can  be  extracted  with  more  ease  and  less  danger  of  in- 
jury to  the  alveolar  processes,  with  forceps  than  with  the 
key  instrument,  and  as  the  directions  given  by  the  author 
upon  the  subject  apply  exclusively  to  the  latter,  the  editor 
will  add  such  as  he  deems  necessary  for  the  former.  But 
before  he  does  this,  he  will  advert  briefly  to  the  directions 
given  by  the  author,  with  regard  to  the  manner  of  apply- 
ing the  key  to  the  second  and  third  inferior  molares.  In 
the  application  of  the  instrument  to  these  teeth,  he  recom- 

*  Plate  XXIII.  Fig.  1. 


226  EXTRACTION    OF    THE 

mends  placing  the  bolster  or  fulcrum  on  the  outside  of 
the  tooth,  and  the  reasons  which  he  offers  for  so  doing 
should  at  once,  determine  the  application  of  it  on  the 
other  side.  As  these  teeth  incline  inwardly,  the  direction 
of  the  force  exerted  by  the  key  when  the  fulcrum  is 
placed  on  the  outside,  is  on  a  line  which  forms  a  more 
abrupt  angle  with  the  tooth  than  when  it  is  applied  on 
the  inside,  and  consequently  requires  a  much  greater 
amount  of  power  for  its  removal,  and  in  proportion  to 
which,  is  the  danger  of  injury  to  the  alveolus  increased. 
When,  therefore,  the  key  instrument  is  used  for  the 
extraction  either  of  the  second,  third,  or  first  molaris  or 
bicuspides  of  the  lower  jaw,  the  fulcrum  of  the  instrument 
should  be  placed  on  the  inside  of  the  tooth.  And  as  a 
general  rule,  it  should  be  placed  on  the  inside  in  the 
extraction  of  the  upper  molares  or  bicuspides. 

For  the  extraction  of  the  bicuspides  of  either  jaw,  and 
the  inferior  cuspidati,  the  forceps  represented  in  Fig.  2, 
Plate  XXIV.  should  be  used.  The  gum  having  been 
perfectly  separated  from  the  neck  of  the  tooth,  the  for- 
ceps should  be  placed  on  it  as  high  up  or  low  down  as  it 
may  happen  to  be,  in  the  upper  or  lower  jaw,  as  possi- 
ble, grasping  it  sufficiently  tight  to  prevent  the  instru- 
ment from  slipping  and  not  tight  enough  to  fracture  the 
tooth,  it  should  be  quickly  pressed  outwards  and  inwards 
until  it  begins  to  yield  or  give  way  in  the  socket,  when  it 
should  be  raised  with  a  very  slight  rotary  motion  from 
the  alveolus.  But  if  the  tooth  above  the  alveolus,  is  so 
much  weakened  by  caries  as  to  be  unable  to  bear  the 
pressure  of  the  instrument,  the  gum  should  be  laid  open 
vertically  with  a  sharp  lancet,  for  an  eight  of  an  inch  or 
more  if  necessary  on  the  alveolus,  and  this  grasped  suffi- 
ciently high  up,  if  the  tooth  be  in  the  upper  jaw,  and 
low  down,  if  it  be  in  the  lower,  to  reach  a  sound  part  of 


B1CUSPIDES    AND    MOLARES.  227 

the  root,  with  the  narrow-beaked  forceps  represented  in 
Fig.  4,  Plate  XXV.,  which,  by  a  little  pressure,  on  the 
handles,  will  be  cut  through,  when  the  affected  organ 
may  be  easily  removed. 

The  lower  cuspidati  should  be  extracted  in  nearly  the 
same  manner,  when  similarly  circumstanced,  but  when 
their  roots  are  not  funneled  out  by  caries,  the  forceps 
represented  in  Fig.  2,  Plate  XXIV.  should  be  employed 
for  their  removal. 

It  may  be  as  well  to  observe  here,  that  it  often  happens, 
when  a  tooth  decays  on  the  side  next  to  an  adjoining 
tooth,  the  last,  by  the  approximation  of  the  two,  infringes 
upon  the  first  in  such  a  manner,  as  to  oppose  a  formidable 
obstacle  to  its  removal — one  which  can  only  be  overcome 
by  filing  away  a  portion  of  the  encroaching  organ.  In  a 
case  of  this  description,  no  attempt  should  be  made  to 
extract  the  carious  tooth,  until  so  much  of  the  adjoining 
one  as  has  impinged  upon  it,  has  been  removed  with  a 
file.  If  this  precaution  be  neglected,  two  teeth,  if  no 
more  serious  injury  should  result,  will  be  removed  instead 
of  one. 

The  directions  given  for  the  extraction  of  the  bicuspides 
and  lower  cuspidati,  will,  in  most  instances,  be  found  ap- 
plicable for  the  removal  of  the  dentes  sapientiae.  It 
sometimes  happens  however,  that  when  the  lower  dentes 
sapientiae  are  situated  far  back  under  the  coronoid  pro- 
cesses they  are  somewhat  difficult  of  removal,  but  with 
forceps,  such  as  represented  in  Fig.  2,  Plate  XXIV.  and 
a  little  tact,  on  the  part  of  the  dentist,  they  may  be 
grasped  and  removed.  If  the  crown  be  decayed  off 
down  to  the  alveolus,  the  narrow-beaked  forceps  should 
be  used,  and  in  their  application,  the  upper  edge  of  the 
socket  should  be  included  between  the  nibs  of  the  beak 
of  the  instrument.     It  sometimes  happens  too,  that  the 


228  EXTRACTION    OF    THE 

roots  of  these  teeth  are  bent  in  such  a  way  as  to  consti- 
tute a  considerable  obstacle  to  their  removal,  but  a  little 
patience  and  management  on  the  part  of  the  operator 
will  enable  him  to  extricate  them.  When  the  crowns 
of  the  second  molares  in  the  upper  jaw  are  very  much 
longer  than  those  of  the  dentes  sapientiae,  the  forceps 
represented  in  Fig.  4,  Plate  XXIV.  should  be  employed 
for  the  removal  of  the  last  named  teeth,  instead  of  the 
ones  last  referred  to. 

The  superior  molares  having  three  roots  are  generally 
more  firmly  articulated  than  any  of  the  other  teeth,  and 
as  a  consequence,  usually  require  more  force  for  their 
removal.  When  therefore,  one  of  these  teeth  is  to  be 
extracted,  it  should  be  firmly  grasped  high  up  under  the 
gums,  with  one  of  the  forceps  represented  in  Figs.  2  and 
3,  Plate  XXV.  and  pressed  outwards  and  inwards,  until 
it  begins  to  yield  in  the  socket,  then  by  depressing  the 
instrument  it  should  be  removed.  The  forceps  for  the 
removal  of  the  upper  molares  should  be  strong  and  accu- 
rately fitted  to  the  teeth,  and  when  of  the  proper  shape 
and  construction  they  are  the  safest  and  best  instruments 
that  can  be  used  for  their  extraction. 

Although  the  inferior  molares  have  but  two  roots,  they 
are  often  very  firmly  articulated,  and  require  considerable 
force  for  their  removal;  yet  with  forceps  such  as  repre- 
sented in  Fig.  1,  Plate  XXV.  in  the  hands  of  a  good 
operator,  they  can  usually  be  extracted  without  difficulty. 
The  points  on  the  ends  of  the  nibs  of  the  beak,  should, 
in  the  application  of  the  instrument,  be  forced  down 
between  the  roots  of  the  tooth,  which  being  firmly  grasped 
should  be  forced  several  times,  outwards  and  inwards, 
and  as  soon  as  it  begins  to  move  freely  in  the  socket,  it 
should  be  raised  from  it.  When  the  crown  of  the  tooth 
has  decayed  otf,  a  portion  of  the  alveolus  on  each  side 


ROOTS    OF    TEETH.  229 

should  be  included  between  the  points  of  the  nibs  of  the 
forceps,  and  cut  through  in  the  manner  as  before  de- 
scribed. This  done,  a  firm  hold  is  obtained  upon  the 
tooth,  which  now  may  easily  be  removed. 

The  position  of  the  operator,  while  extracting  a  tooth, 
whether  in  the  upper  or  lower  jaw,  or  on  the  right  or 
left  side,  should  always  be  at  the  right  and  a  little  behind 
the  patient.  This  position  gives  him  an  opportunity  of 
controlling  his  head,  and  guarding  the  instrument  more 
effectually  than  he  could  do  were  he  to  occupy  any  other 
position.  And  as  a  general  rule,  the  instrument  should 
rest  upon  the  palm  of  his  hand,  while  he  is  using  it.] 

DIRECTIONS   FOR  THE   EXTRACTION    OF    ROOTS  OF  TEETH. 

Stumps  are  often  extracted  with  much  ease;  they  are 
sometimes  so  much  thrust  out  by  the  socket  as  to  require 
very  little  force  for  their  removal;  but  in  other  instances, 
there  is  great  difficulty,  from  the  depth  at  which  they  are 
placed   in   the  jaw,  and   the  very  decayed   state  of  the 
exposed  part.     Stumps  can  rarely  be  extracted  with  the 
key  instrument,  as  a  sufficient  purchase  for  the  claw  can 
scarcely  be  obtained,  they  must  therefore  be  extracted 
with  the  punch.     The  mode  of  using  this  instrument  is 
as  follows;  the  gum  should  be  well  separated  with  the 
lancet,  that  the  instrument  may  be  applied  to  a  sound 
part  of  the  stump;  it  is  then  to  be  pushed  with  a  steady 
force,  sufficient  to  displace  the  stump  from  the  socket. 
As  there  is  danger  that  the  punch  may  slip,  and  tear 
some  part  of  the  mouth,  care  should  be  taken  to  avoid 
such  an  accident,  by  wrapping  a  cloth  around  the  fore- 
finger of  the  left  hand,  which,  being  introduced  into  the 
mouth,  will  receive  the  point  of  the  instrument,  should  it 
slip,  and  prevent  any  injury  from  being  inflicted. 
30 


230  EXTRACTION    OF    THE 

[In  addition  to  the  punch,  an  elevator,  hook  and 
screw,  instruments  too  well  known  by  every  dentist  at  the 
present  day  to  need  description,  are  now  used  in  the 
extraction  of  roots  of  teeth.  The  punch,  elevator  and 
hook,  are  used  chiefly  for  the  extraction  of  the  roots  of 
the  bicuspides  and  molares.  The  two  former  for  the 
removal  of  roots  on  the  right  side  of  the  mouth,  and  the 
latter,  for  the  removal  of  roots  on  the  left  side. 

In  using  the  punch  or  elevator,  care  is  necessary  to 
prevent  the  instrument  from  slipping  and  inflicting  injury 
on  the  soft  parts  of  the  mouth.  With  the  hook  there  is 
not  so  much  danger.  The  manner  of  using  the  elevator, 
is  to  force  the  instrument  between  two  roots  or  one  root 
and  a  sound  tooth,  and  then  by  turning  it,  the  edge 
against  the  root  to  be  removed,  and  the  back  against  the 
adjoining  tooth  or  root,  the  root  to  be  removed,  is  lifted 
from  the  socket.  The  hook  acts  upon  pretty  much  the 
same  principle  as  the  punch. 

The  narrow-beaked  forceps,  however,  previously  de- 
scribed, are  much  better  adapted  for  the  removal  of  the 
roots  of  the  bicuspid  and  molar  teeth  than  either  the 
punch,  elevator  or  hook,  and  in  the  hands  of  those  who 
have  made  trial  of  them,  it  has  superceded  their  use 
almost  altogether.  It  can  be  more  easily  used,  and  is  a 
much  safer  and  more  efficient  instrument. 

The  screw  employed  for  the  extraction  of  roots  of 
teeth,  is  of  a  conical  shape,  somewhat  like  that  of  the 
roots  of  the  incisores  and  cuspidati,  and  for  the  removal 
of  which,  it  is  especially  designed.  After  the  loss  of  the 
crown  of  one  of  these  teeth,  the  caries  oftentimes  extends 
up  the  roots,  tunneling  it  out,  and  leaving  only  a  thin 
exterior  shell,  which  is  too  weak  to  bear  the  requisite 
amount  of  pressure  from  forceps  for  its  removal.  But 
after  removing  the  softened,  decomposed  bone  from  the 


ROOTS    OF    TEETH.  231 

interior,  with  a  screw  like  the  one  here  described,  firmly 
introduced,  it  may  easily  be  removed. 

On  the  conical  screw  which  has  been  in  use  for  a  long 
time,  Dr.  Hullihen  of  Wheeling,  Va.  has  made  a  highly 
valuable  improvement,  consisting  of  a  combination  of  this 
with  a  pair  of  forceps,  which  he  designates  "  Compound 
Root  Forceps."  A  representation  of  them  is  exhibited  in 
Fig.  3,  Plate  XXIV.  and  the  editor  will  here  quote  the 
description  which  he  has  given  of  them. 

He  says,  "the  above  named  forceps,  were  contrived 
some  time  since,  for  the  purpose  of  extracting  hollow 
roots  of  teeth,  with  more  expedition  and  at  the  same 
time,  with  less  pain  to  the  patient  than  was  possible  with 
the  instrument  in  general  use,  and  as  the  forceps  have 
fully  answered  the  purpose  for  which  they  were  intended, 
I  have  thought  them  of  sufficient  importance  to  lay  them 
before  the  profession. 

The  compound  root  forceps  are  about  nine  inches  in 
length,  and  like  the  common  straight  forceps  with  the 
exception  that  the  beak  is  much  longer,  and  much  nar- 
rower and  thinner  at  the  point.  Lengthwise,  within  and 
between  the  blades  of  the  beak  is  a  steel  tube,  one  end  of 
which  is  open;  the  other  solid  and  flat  and  jointed  in  a 
mortise  in  the  male  part  of  the  forcep's  joint.  When  the 
forceps  are  opened,  this  joint  permits  the  tube  to  fall 
backwards  and  forwards  from  one  blade  of  the  beak  to 
the  other,  without  any  lateral  motion.  Within  this  tube 
is  a  spiral  spring,  which  forces  up  the  shaft,  two-thirds  of 
the  length  of  the  shaft  is  rounded  and  fitted  neatly  into 
the  tube,  the  other  part  is  a  well  tapered  or  conical  screw. 
The  shaft  is  retained  in  the  tube  by  a  small  screw,  that  is 
fixed  into  the  shaft  through  a  notch  half  an  inch  long  in 
one  side  of  the  tube.  The  shaft  and  tube  are  so  fitted 
together,  and  to  the  beak  of  the  forceps,  that  one-half  of 


232        EXTRACTION    OF    THE    ROOTS    OF    TEETH. 

the  rounded  part  of  the  shaft  projects  beyond  the  end  of 
the  tube;  so  that  the  shaft  may  play  up  and  down  upon 
the  spring,  the  length  of  the  notch;  and  the  screw  part  pro- 
jecting beyond  the  point  of  the  forceps;  so  that  the  shaft 
may  be  embraced  between  its  blades^  just  behind  the  base 
of  the  screw.  A  full  sided  view  of  the  beak  of  the 
forceps  with  its  tube  and  shaft  is  well  represented  in  the 
cut; — for  a  copy  of  which  see  Fig.  3;  Plate  XXIV. 

The  forceps  are  used;  by  first  embracing  the  shaft 
between  the  blades.  Then  screwing  it  gently  and  as 
deeply  into  the  root  as  possible;  the  blades  are  opened  and 
pushed  up  upon  the  root;  which  is  then  seized  in  either 
of  the  ways  as  the  case  may  require. 

The  screw  thus  combined  with  the  forceps;  prevents 
the  root  from  being  crushed.  It  acts  as  a  powerful  lever 
when  a  lateral  motion  is  given ;  it  is  likewise  of  advantage 
when  a  rotary  motion  is  made;  as  it  prevents  the  forceps 
from  slipping;  or  of  their  action  being  lost;  should  even 
one  side  of  the  root  give  way  in  the  act  of  extracting  it; 
and  is  used  with  equal  advantage  where  one  side  of  the 
root  is  entirely  gone.  In  short,  this  combination  of  the 
screw  and  forceps  forms  an  instrument  which  fulfils  every 
indication  that  can  be  desired  in  the  extraction  of  hollow 
roots. 

The  shaft  of  the  compound  forceps  is  easily  changed ; 
a  number  of  different  sized  screws  may  therefore  be  used 
in  the  same  pair  of  forceps. " 

In  conclusion;  the  editor  would  remark;  that  he  has 
tested  the  merits  of  this  instrument;  and  can  recommend 
it  to  the  profession  as  one  of  great  value.] 


USE    OF    THE   KEY    INSTRUMENT.      '  233 

[PARTICULAR  DIRECTIONS  FOR  THE   USE   OF   THE   KEY 
INSTRUMENT.] 

In  extracting  a  toothy  the  first  thing  to  be  considered, 
is  the  choice  of  a  claw  adapted  to  the  size  of  a  tooth :  it 
should  neither  be  too  large,  nor  too  small:  if  it  be  too 
large,  there  is  great  danger  of  breaking  away  a  large 
portion  of  the  alveolar  process;  and,  if  it  be  too  small,  as 
it  can  only  act  upon  the  crown  of  the  tooth,  there  will  be 
almost  a  certainty  of  breaking  it  off,  and  leaving  the  fangs 
in  the  socket. 

In  Plate  XXIII.  are  too  examples  of  the  dangerous 
consequences  of  attempting  to  use  an  instrument  with  too 
large  a  claw,  Fig.  7  is  the  representation  of  all  the  mo- 
lares  of  the  upper  jaw  that  were  torn  from  the  mouth  of 
a  gentleman,  by  an  injudicious  operator,  in  attempting  to 
extract  one  of  them,  which  was  decayed. 

Fig.  8,  represents  the  dens  sapiential  of  the  lower  jaw, 
of  a  lady,  which  was  attempted  to  be  extracted  inwardly 
with  too  large  an  instrument;  the  consequence  was,  the 
bringing  away  a  large  piece  of  the  jaw  with  the  tooth,  as 
described. 

The  fixing  an  instrument  upon  the  tooth  is  a  circum- 
stance which  ought  particularly  to  be  attended  to,  as 
many  teeth  have  been  broken  for  want  of  regarding  this 
circumstance. 

The  key  instrument,  in  the  extraction  of  a  tooth,  acts 
precisely  upon  the  principle  of  a  lever  of  the  first  kind. 
It  is  an  improvement  upon  the  very  ancient  instrument 
called  the  pelican,  which  consisted  of  a  claw  laying  hold 
of  the  tooth,  a  fulcrum  to  press  upon  the  jaw,  and  a 
straight  handle  by  which  to  exert  the  power.  In  the 
present  form  of  the  instrument,  the  claw,  or  hook,  forms 
the  point  of  the  lever,  the  bolster  the  fulcrum,  and  the 


234  PARTICULAR    DIRECTIONS    FOR    THE 

handle,  which  is  now  placed  at  a  right  angle  with  respect 
to  the  claw,  is  the  part  with  which  to  exert  the  power. 

The  point  of  the  claw  should  always  be  fixed  as  far  as 
possible  on  the  neck  of  the  tooth,  that  the  power  may  act 
upon  the  fangs ;  and  the  bolster  should  be  fixed  on  the 
opposite  side,  rather  below  the  point  of  the  claw.  When 
an  instrument  is  thus  fixed,  and  power  is  applied  by  turn- 
ing the  handle,  it  immediately  acts,  by  raising  the  tooth.* 
But,  if  the  point  of  the  claw7  and  the  fulcrum  be  in  direct 
opposition  to  each  other,  the  increasing  of  the  power  only 
pinches  the  crown  of  the  tooth,  and  does  not  act  so  as  to 
raise  the  fangs.  In  this  case,  the  crown  of  the  tooth 
must  be  broken  off,  without  moving  the  fangs,  or  the 
claw7  will  be  broken  in  the  centre  of  its  curve. f 

When  the  instrument  has  been  fixed  in  a  proper  man- 
ner, the  next  thing  to  be  regarded  is  the  best  mode  of 
using  it. 

There  is  one  method  of  using  the  instrument  which 
cannot  be  too  strongly  reprobated,  as  it  is  sometimes 
attended  with  the  most  mischievous  consequences;  this 
is,  the  attempting  to  extract  a  tooth  quickly,  by  turning 
the  instrument  in  a  sudden,  violent  manner.  I  have 
known  many  accidents  result  from  this  practice,  and 
therefore  cannot  but  condemn  it  in  the  strongest  terms. 
No  tooth  can  be  extracted  safely,  unless  its  attachment  to 
the  jaw  be  overcome  by  a  force,  which  being  gradu- 
ally increased,  will  cause  the  parts  concerned  to  yield 
with  safety.  For  want  of  attending  to  this  principle, 
various  distressing  accidents  have  been  occasioned ;  com- 
monly the  teeth  are  broken  in  the  socket,  and  sometimes 
part  of  the  jaw  itself;  and  often  the  alveolar  processes 
are  extensively  fractured.  About  six  years  ago,  I  atten- 
ded a  lady  who  suffered  most  dreadfully,  for  a  great 

*  Plate  XXlUFi?.  f.  t  Fig.  6. 


USE    OF    THE    KEY    INSTRUMENT.  235 

length  of  time,  from  having  a  tooth  extracted  in  this  sud- 
den manner.     The  gentleman  who  performed  the  opera- 
tion, removed  the  tooth,  the  second  bicuspis  in  the  lower 
jaw,  with  a  very  sudden  jerk  of  the  instrument;    two  or 
three  days  afterwards,  the  face  became  much  swollen,  and 
a  considerable  quantity  of  matter  formed;  this  was  dis- 
charged at  the  socket  from  which  the  tooth  had  been 
drawn.     The  lady  was  in  this  state  when  I  saw  her;  the 
discharge  of  matter  w7as  very  considerable,  and  the  other 
bicuspis  was  somewhat  loosened;   it  was  very  tender  to 
the  touch,  and  appeared  to  be  a  cause  of  irritation:   it 
was,  therefore,  judged  expedient  to  remove  it.     The  pain 
and  discharge  of  matter  still  continued,  and  small  pieces 
of  bone  worked  out  of  the  gum;  at  length  the  abscess 
extended  to  the  socket  of  the  first  molaris,  and  it  became 
so  tender  as  to  make  it  necessary  to  extract  that  tooth. 
Shortly  after  this  had  been  drawn,  some  very  large  pieces 
of  the  jaw  exfoliated;  but  still  the  lady  was  not  relieved 
from  pain,  nor  did  the  abscess  appear  to  be  disposed  to 
heal :  in  a  little  time  afterwards,  the  second  molaris  be- 
came sore,  and  was  affected  by  the  abscess  as  the  other 
teeth  had  been;  and,  therefore,  it  wTas  determined  upon, 
that  this  also  should  be  extracted.      The  removal  of  this 
tooth  permitted  a  piece  of  bone,  more  than  two  inches  in 
length,  to  come  away;  soon  after  which  the  discharge  of 
matter  ceased,  and   the  parts  became  perfectly  healed. 
This  is  an  instance  in  which  three  teeth  were  lost,  besides 
the  originally  diseased  one,  with  extensive  exfoliation  of 
the  jaw,  and  six  months  excessive  pain ;  all  this  resulting 
from  extracting  a  tooth  with  a  violent  jerk 

To  be  able  to  extract  a  tooth  well,  the  surgeon  should 
act  with  firmness  and  self-possession:  having  these  quali- 
fications, he  will  not  be  so  confused  as  to  place  the  instru- 
ment upon  a  wrong  tooth,  nor  act  with  so  much  precipi- 
tation as  to  endanger  the  safety  of  the  patient. 


236  USE    OF    THE    KEY    INSTRUMENT. 

The  observation  of  a  most  distinguished  anatomical 
lecturer,  that  all  operations  are  performed  sufficiently 
quick,  which  are  performed  well,  is  very  applicable  to 
the  extraction  of  a  tooth 

The  plan  that  I  have  always  adopted,  with  the  great- 
est success,  is  gradually  to  increase  the  power  of  the 
instrument  until  the  tooth  be  moved;  and  then,  by  raising 
the  hand,  endeavour  to  draw  the  tooth  in  a  direction  as 
nearly  perpendicular  as  possible. 

Sometimes,  although  the  utmost  care  has  been  taken 
in  the  extraction  of  a  tooth,  a  portion  of  the  alveolar  pro- 
cess will  be  broken  off:  it  may  either  come  away  adhering 
to  the  tooth,  or  it  may  remain  loose  in  the  socket:  it  is, 
therefore,  highly  proper  that  the  gum  should  be  cautiously 
examined,  and,  if  any  loose  splinter  be  felt,  it  must  be 
taken  away:  for  this  purpose  it  is  always  right  to  be  pre- 
pared with  a  pair  of  forceps.  If  any  splinter  should  be 
left  in  the  gum,  it  will  be  productive  of  future  inconve- 
nience, as  the  gum  remains  very  sore,  and  is  kept  from 
healing  until  the  piece  of  bone  has  come  away.  This 
examination  may  always  be  made  at  the  time  of  closing 
the  gums,  without  exciting  any  alarm  in  the  mind  of  the 
patient. 

When  the  crown  of  a  tooth  is  much  decayed,  success 
does  not  always  attend  an  attempt  to  extract  it:  the 
whole,  or  a  part  of  the  fangs  may  remain:  sometimes  the 
gum  will  grow-  over  such  portions  of  the  fangs,  and  then 
they  can  no  longer  be  the  cause  of  uneasiness :  or  the 
socket,  by  closing  at  the  bottom,  will  gradually  thrust 
them  forwards,  until  they  may  readily  be  taken  hold  of, 
and  extracted.  The  pain  of  the  tooth-ache  is  usually 
removed  by  the  destruction  of  part  of  the  nervous  mem- 
brane, or  the  hemorrhage  caused  by  the  operation;  and, 
if  the  stumps  should  afterwards  become  troublesome,  they 
mav,  in  a  few  months,  be  easily  removed. 


HEMORRHAGE    AFTER    EXTRACTION.  237 


HEMORRHAGE   AFTER  EXTRACTION. 

Sometimes,  after  the  extraction  of  a  tooth,  a  consid- 
erable hemorrhage  continues;  the  artery  which  belonged 
to  the  tooth  does  not  contract;  or,  from  being  of  large 
size,  a  coagulum  sufficiently  strong  to  restrain  the  flow  of 
blood  is  not  formed.  Hence  a  great  quantity  of  blood 
may  be  lost.  The  best  mode  of  stopping  this  hemorrhage 
is  by  the  application  of  pressure.  A  piece  of  very  fine 
lint,  or  cotton,  dipped  in  spirits  of  turpentine,  should  be 
pressed  into  the  socket,  over  which  a  large  compress  of 
lint  should  be  laid,  which  may  either  be  pressed  firmly 
with  the  finger,  or,  in  closing  the  mouth,  by  the  teeth  of 
the  other  jaw.  In  this  manner,  a  hemorrhage  may  soon 
be  restrained;  little  or  no  benefit  is  ever  derived  from 
washing  the  gums  with  styptic  remedies,  as  they  cannot 
act  upon  the  mouth  of  the  bleeding  vessel,  and  therefore 
are  ineffectual. 


31 


CHAPTER    SIXTH. 

OF    EXOSTOSIS    OF   THE    FANGS    [OF    THE    TEETH.J 

Oxe  of  the  species  of  exostosis  in  bones,  is  an  enlarge- 
ment arising  from  a  deposit  of  bony  matter,  so  compact 
in  its  structure  as  very  much  to  resemble  ivory.  This  is 
that  kind  of  enlargement  to  which  the  fangs  of  the  teeth 
of  some  persons  are  liable. 

The  cause  of  this  disease  is  obscure,  and  the  slow- 
increase  in  the  size  of  the  fang  is  the  reason  why  pain 
does  not  occur  until  a  considerable  augmentation  of  its 
bulk  has  taken  place. 

It  is  sometimes  found  to  exist  where  the  crowTns  of  the 
teeth  remain  perfectly  sound;  in  other  cases,  it  appears 
to  be  the  effect  of  indolent  inflammation,  arising  from 
caries  in  the  body  of  the  tooth,  and  extending  to  the  fang. 
This  kind  of  disease  does  not  produce  suppuration;  the 
gum  continues  quite  healthy;  but,  whenever  pain  occurs, 
as  no  permanent  relief  can  be  obtained  without  the  ex- 
traction of  the  tooth,  it  becomes  necessary,  when  the  teeth 
are  sound,  to  be  very  attentive  to  distinguish  this  disease 
from  mere  rheumatic  affections  of  the  jaw  bones. 

In  Plate  XVI.  Fig.  12,  are  two  teeth,  the  first  molaris 
of  each  side  of  the  lower  jaw,  which  1  extracted  from  a 
lady,  who  had  complained,  for  a  considerable  length  of 
time,  of  pain  on  both  sides  of  the  face,  arising  from  each 
of  these  teeth.      She  described  her  symptoms  to  be,  a 


OF    EXOSTOSIS    OF    THE    FANGS    OF    TEETH.       239 

constant  uneasiness,  like  the  gnawing  sensation  of  rheu- 
matism, which,  continuing  almost  without  intermission, 
exhausted  her  health  and  spirits.  The  teeth  and  gums 
were  quite  free  from  any  diseased  appearance,  the  pain 
therefore  was  considered  as  rheumatic:  she  had  taken 
much  medicine,  and  continued  under  the  care  of  an 
eminent  practitioner,  for  a  considerable  length  of  time, 
without  receiving  any  benefit.  The  gums  were  lanced, 
blisters  were  applied  behind  the  ears,  but  all  means  were 
ineffectual :  she  at  length  determined  to  have  both  of  the 
teeth  extracted.  This  was  reluctantly  performed,  because 
they  appeared  to  be  perfectly  free  from  disease. 

When  one  tooth  was  removed,  the  cause  of  her 
complaint  became  evident,  for  the  whole  surface  of  the 
fangs  was  increased  in  size  by  the  irregular  addition  of  a 
quantity  of  bony  matter.  This  induced  me  to  comply 
with  her  wish  of  removing  the  other,  which  had  precisely 
the  same  appearance.  The  cause  of  her  pain  now  became 
certain;  the  increase  in  the  size  of  the  fangs  necessarily 
occasioned  a  distention  of  the  alveolar  cavity,  and  kept 
up  a  constant  uneasiness.  The  lady  was  immediately 
relieved,  and  recovered  her  health  and  spirits,  to  the 
great  joy  of  her  family,  who  were  nearly  deprived  of  her 
society,  by  reason  of  her  excessive  nervous  irritability. 

Where  this  disease  has  occurred  in  teeth  already 
carious,  the  persons  have  not  been  afflicted  with  extreme 
tooth-ache,  but  they  have  had  occasional  uneasiness, 
which  at  length  has  become  more  uninterrupted,  and  the 
tooth  has  projected  to  a  certain  degree  from  the  socket,  so 
that  in  closing  the  mouth  the  tooth  felt  as  if  out  of  its 
natural  situation,  thus  rendering  mastication  painful. 
When  extracted,  the  fangs  have  been  found  enlarged  as 
in  the  teeth  represented  in  Fig.  13,  Plate  XVI. 

Some  persons  will  refer  this  appearance  upon  the  fangs 


240        OF    EXOSTOSIS    OF    THE    FANGS    OF    TEETH. 

of  the  teeth  to  an  original  mal-formation ;  but  so  different 
is  it  in  appearance  from  the  smooth  structure  of  any  ill- 
formed;  crooked;  or  undiseased  tooth;  and  when  extrac- 
ted; so  much  whiter  than  any  other  part  of  the  fang;  that 
it  can  only  be  referred  to  diseased  action;  occasioning  a 
deposit  of  bony  matter;  as  in  other  cases  of  exostosis. 

Of  this  disease  of  the  teeth;  the  most  extraordinary 
case  on  record  occurred  to  a  young  lady  scarcely  twenty 
years  of  age.  The  following  letter,  from  the  surgeon 
who  had  attended  the  lady;  and  by  whom  she  was  intro- 
duced to  me;  presents  a  full  narrative  of  the  case. 

Sir;  9th  JYov.  1809. 

Miss ;  the  young  lady  who  will  deliver  this  to 

you;  has  been  under  my  care  for  near  twelve  months; 
with  a  very  extraordinary  complaint  in  her  face;  teeth 
and  gums.  It  commenced  with  a  deep-seated  pain  in 
the  face;  confined  principally  to  one  side;  returning  most 
mornings  at  about  eleven  o'clock;  and  continuing  several 
hours.  This  had  gone  on  for  near  three  months;  before 
she,  or  her  friends,  thought  it  sufficiently  serious  to  call 
in  any  medical  assistance.  When  first  I  saw  her;  she 
had  suffered  great  pain  all  that  day;  from  the  teeth;  gums, 
and  face :  on  one  side  the  gums  were  rather  swollen  and 
inflamed ;  and  as  one  of  the  teeth  was  slightly  decayed;  I 
thought  it  most  advisable  to  extract  it;  which  gave  relief 
till  the  next  day,  when  the  pain  returned  with  still  greater 
violence;  so  much  so,  that  she  was  desirous  of  having 
the  adjoining  tooth  taken  out,  which  she  fancied  gave  her 
more  pain  than  the  rest.  This  had  the  same  effect  as  the 
other,  only  giving  relief  till  the  next  day,  when  the  pain 
returned  with  equal  violence.  I  then  tried  scarifying  the 
gums,  cold  lotion  to  the  face,  giving  at  the  same  time  a 
brisk    purgative;  and   afterwards  an   opiate.     This   was 


OF    EXOSTOSIS    OF    THE    FANGS    OF    TEETH.  241 

continued  for  a  short  time  without  abating  the  pain;  I 
then  changed  the  plan  for  the  more  soothing  one  of  fo- 
mentation and  poultice,  applying  a  fig  to  the  gums,  occa- 
sionally changing  it  for  a  crust  of  bread  soaked  in  warm 
milk;  taking  at  the  same  time  a  saline  and  opiate  draught 
every  four  hours;  but  with  just  the  same  effect  as  the 
preceding  remedies.  In  short,  the  pain  in  the  teeth  and 
face  continued,  the  gums  became  partially  ulcerated,  and 
in  the  course  of  six  months,  I  was  under  the  necessity  of 
extracting,  at  different  times,  all  the  teeth  in  the  lower 
jaw,  excepting  the  four  incisores,  which  very  soon  became 
affected  in  a  similar  way  to  the  rest:  these  her  friends 
would  not  allow  to  be  drawn;  nor  was  I  desirous  of  per- 
forming the  operation,  as  the  removal  of  the  others  did 
not  appear  to  have  given  any  permanent  relief,  excepting 
that  the  gums  healed,  and  remained  well  where  the  teeth 
had  been  extracted.  During  this  time  almost  every  re- 
medy that  could  be  thought  of  was  tried,  such  as  frequent 
scarifying  of  the  gums,  leeches,  permanent  blisters  to  the 
lower  jaw  and  behind  the  ears,  astringent  lotions,  as  the 
infusion  of  roses  with  the  tincture  of  myrrh,  decoctions  of 
bark,  oak  bark,  infusion  of  galls,  solutions  of  alum,  argen- 
tum  nitratum,  salt  and  water,  lemon-juice,  oxymel  aeru- 
ginis,  borax,  charcoal  and  soda,  tepid  bath,  artificial  sea 
bath,  and  afterwards  sea  bathing,  seton  in  the  neck,  issue 
in  the  arm,  &lc.  &lc.  with  a  great  many  other  applications 
which  it  would  be  useless  to  name.  Internally  she  has 
taken  strong  purgatives,  calomel  combined  with  antimony, 
and  afterwards  continued  alone  in  small  doses  to  saliva- 
tion, solutio  mineral,  solut.  calc.  muriat.  bark,  with  nitrous 
acid,  steel,  lemon-juice  in  large  quantity,  tinct.  opii.  to 
the  amount  of  gut.  60  at  bed  time,  and  repeated  in  small 
doses  during  the  day  at  short  intervals,  cicuta,  &c.  &,c. 
prescribed  by  an  eminent  physician  of  this  place,  without 


242    OF  EXOSTOSIS  OF  THE  FANGS  OF  TEETH. 

receiving  little  more  than  slight  temporary  relief  from  any 
one  medicine  prescribed.  She  has  now  all  the  teeth  of 
the  upper  jaw  affected  in  a  similar  way  to  the  lower;  the 
palpebral  of  one  eye  have  been  closed  for  near  two 
months,  and,  when  opened,  can  discern  objects  but  very 
imperfectly;  the  secretion  of  saliva  has  for  some  time 
been  so  copious  as  to  flow  from  the  mouth  whenever 
opened.  She  is  now  come  to  London,  purposely  for  ad- 
vice, and  I  have  recommended  that  she  should  call  upon 
you. 

I  remain,  Sir, 

Your  obedient  servant, 
T.  S. 

This  letter  not  only  fully  describes  the  very  afflicting 
case,  but  also  shows  that  medicine  under  every  form  had 
altogether  failed :  of  course  no  benefit  could  be  expected 
from  a  repetition  of  any  similar  treatment. 

At  the  time  I  saw  the  lady,  she  was  only  able  to  take 
fluid  nutriment,  for  the  teeth  of  the  upper  jaw  were  so 
very  tender  that  the  slightest  touch  caused  extreme  pain. 
As  described  by  Mr.  S.  the  flow  of  saliva  was  so  consid- 
erable that  there  was  a  continual  necessity  of  discharging 
it.  The  lady  herself  said  she  was  assured  she  should 
never  get  well,  unless  all  her  teeth  were  extracted.  It 
was  however  desired  if  possible  to  seek  such  relief  as 
should  prevent  so  painful  an  expedient  which  could  only 
be  regarded  as  the  last  resort. 

Dr.  Babington  and  Mr.  Cline  were  consulted,  who 
prescribed  a  blister  on  the  head,  to  be  kept  open  by  the 
application  of  the  ceratum  sabina?.  This  was  tried  with- 
out success.  The  pain  in  the  mouth,  the  soreness  of  the 
teeth,  and  the  general  irritation  on  the  constitution,  all 
combined  to  render  the  extraction  of   the  most  painful 


OF    EXOSTOSIS    OF    THE    FANGS    OF    TEETH.     243 

tooth  advisable.  This  was  the  first  molaris  of  the  upper 
jaw,  situated  under  that  eye,  the  palpebral  of  which  had 
become  closed. 

The  fangs  of  this  tooth  were  much  enlarged;  and  from 
the  periosteum  being  greatly  thickened,  the  fangs  had  the 
appearance  of  being  cartilaginous.  The  removal  of  this 
tooth  was  attended  with  great  benefit;  as,  in  two  days 
after  the  operation,  the  affected  eyelids  so  much  recover- 
ed, as  to  open  simultaneously  with  those  of  the  other  eye. 
This  relief  unhappily  was  of  short  duration:  and  as  the 
other  teeth  remained  very  sore,  the  lady  determined  to 
have  them  extracted  one  after  the  other.  She  submitted 
to  this  operation,  every  two  or  three  days.  The  fangs  of 
those  teeth  which  had  caused  the  most  pain,  were  the 
most  enlarged;  but  each  partook  of  the  disposition  to 
exostosis. 

The  relief  from  pain  which  was  experienced  by  the 
loss  of  the  teeth  was  so  great,  that  with  the  utmost  reso- 
lution this  afflicted  lady  persevered  until  every  tooth  was 
extracted.  After  the  loss  of  the  teeth,  from  time  to  time, 
portions  of  the  alveolar  processes  exfoliated,  which  ren- 
dered it  necessary  to  scarify  the  gums.  I  am  happy  to 
say  that  a  material  improvement  has  taken  place  in  the 
general  health,  although  not  so  perfectly  as  could  be  de- 
sired. One  most  important  benefit  resulted  from  the 
removal  of  the  teeth,  in  arresting  the  progress  of  the 
other  diseased  actions :  for  the  other  eye  had  begun  to  be 
affected;  and  sometimes  was  so  dim,  as  scarcely  to  enable 
the  lady  to  guide  herself  about  the  house.  In  point  of 
appearance,  howTever,  I  had  the  satisfaction  of  completely 
restoring  the  lady,  the  teeth  which  had  been  extracted 
were  replaced,  as  an  artificial  set;  which,  with  the  great- 
est comfort  she  has  now  used  for  more  than  twelve 
months. 


244    OF  EXOSTOSIS  OF  THE  FANGS  OF  TEETH. 

[To  the  foregoing  highly  interesting  and  very  remark- 
able case,  the  editor  could  add  several  others,  but  as 
most  of  them  have  been  elsewhere  noticed,  he  does  not 
think  it  necessary  to  extend  the  limits  of  this  work  by 
their  introduction  here.  With  the  exception  of  necrosis, 
this  is  the  only  disease  of  the  teeth  which  bears  the  least 
analogy  to  any  of  the  morbid  affections  that  are  met  with 
in  the  other  osseous  structures  of  the  body.  The  cause 
of  exostosis,  has  never  been  satisfactorily  explained. 
Some  writers  suppose  it  to  be  the  result  of  inflammation 
of  the  dental  periosteum,  but  as  it  often  attacks  the  roots 
of  sound  teeth,  it  is  most  likely  dependent  on  some  pecu- 
liar constitutional  idiosyncrasy.] 


CHAPTER    SEVENTH. 

Or    NECROSIS    AFFECTING    THE    TEETH. 

When  a  bone,  or  part  of  a  bone,  has  completely  lost 
its  living  principle,  it  is  precisely  in  the  same  state  as  soft 
parts  when  affected  by  gangrene:  no  restoration  of  the 
part  can  be  effected,  the  surrounding  parts  become  in- 
llamed,  and  an  action  takes  place,  which  has  for  its  object 
the  separation  of  the  dead  from  the  living  part.  When 
the  fang  of  a  tooth  has  lost  its  life,  the  whole  of  the  tooth 
becomes,  in  consequence,  an  extraneous  body;  and,  as  in 
bones,  the  cure  of  necrosis  depends  upon  the  exfoliation 
of  the  dead  piece;  so,  in  the  case  of  the  tooth,  the  cure 
can  alone  be  effected  by  its  entire  removal. 

This  disease  usually  affects  teeth  which  are  perfectly 
free  from  caries.*  And  it  is  more  particularly  confined 
to  the  front  teeth,  the  others  being  rarely  affected  in  this 
way.  When  the  fang  of  a  tooth  has  lost  its  living  prin- 
ciple, the  socket  becomes  inflamed,  the  gum  appears  of  a 
darkish  red  colour,  loose  in  its  texture,  and  matter  begins 
to  be  discharged.  In  some,  the  discharge  is  from  two  or 
three  orifices  through  the  gums,  opposite  to  the  extremity, 
or  the  middle  of  the  fang  of  the  tooth ;  in  other  cases  the 
matter  passes  out  at  the  neck  of  the  tooth.  In  all,  there 
is  an  uneasy  pain,  and  the  discharge  of  the  matter  is  very 
disagreeable. 

'Although  teeth   which  in  other  respects  are  sound,  are  frequently  deprived  of 
vitality,  it  is  by  no  means  uncommon  for  carious  teeth  to  be  affected  by  necrosis. 

32 


246         OF    NECROSIS    AFFECTING    THE    TEETH. 

During  the  progress  of  this  disease,  the  alveolar  pro- 
cesses are  absorbed,  [wasted]  and  the  teeth  are  loosened, 
from  which  great  inconvenience  arises. 

In  the  early  stage  of  this  disease,  considerable  benefit 
attends  the  scarification  of  the  gums;  the  loss  of  blood 
abates  the  inflammation;  and,  as  it  is  very  unpleasant  to 
lose  a  front  tooth,  we  may,  by  repeatedly  lancing  the 
gums,  arrest  the  progress  of  the  disease  for  a  considerable 
time;  but,  when  it  has  proceeded  so  far  as  to  loosen  the 
tooth,  it  is  better  to  extract  it,  especially  as  the  whole  of 
the  uneasiness  arises  from  the  tooth  being  an  extraneous 
body;  the  discharge  then  ceases,  and  the  gum  becomes 
perfectly  healed  in  a  short  time.  After  extraction,  the 
fang  of  the  tooth  is  always  found  to  be  very  rough;  in 
most  cases  it  is  dark  coloured,  being  of  a  deep  green, 
brown,  or  black  colour.  In  Plate  XVII.  are  several 
teeth  illustrative  of  this  appearance.  [The  cause  of  this 
affection,  as  has  been  before  stated,  is  inflammation  and 
suppuration  of  the  lining  membrane.] 


CHAPTER    EIGHTH. 

OF    THE    DISEASE    RESEMBLING    SPINA    VENTOSA. 

Spina  Ventosa  is  the  term  usually  given  to  that 
species  of  tumor  in  bone,  which  is  originally  an  abscess 
forming  in  the  centre :  the  ulcerative  process  removing 
the  bone  from  the  inside,  whilst  there  is  a  correspondent 
increase  on  the  outside. 

This  disease,  according  to  my  observation,  is  confined  to 
the  incisores  and  cuspidati  of  the  upper  jaw;  it  produces 
upon  the  gum  and  socket  similar  effects  to  the  disease 
last  described.  The  seat  of  the  malady  is  in  the  cavity  of 
the  tooth ;  the  vessels  ramifying  on  its  membrane  acquire 
a  diseased  action,  by  which  the  membrane  becomes 
thickened,  absorption  of  some  of  the  internal  part  of  the 
tooth  takes  place,  and  the  opening  at  the  extremity  of 
the  fang  also  becomes  enlarged.  This  disease  of  the 
membrane  is  attended  with  the  formation  of  matter  dis- 
charging itself  at  the  point  of  the  fang  into  the  alveolar 
cavity,  which,  being  rendered  more  porous  by  the  process 
of  absorption,  affords  an  easy  exit.  During  the  progress 
of  the  disease,  the  gum  covering  the  alveolar  process 
becomes  inflamed,  and  acquires  a  spongy  texture;  the 
matter  passing  from  the  socket  makes  its  escape  into  the 
mouth  by  several  openings  through  the  gum,  which  is 
thus  kept  in  a  constant  state  of  disease.  The  discharge, 
which  is  generally  considerable,  produces  great  fetor  of 


248  DISEASE    RESEMBLING    SPINA    VENTOSA. 

the  breath,  the  taste  is  constantly  affected,  and  the  socket 
is  gradually  absorbed  until  the  tooth  becomes  quite  loose. 
[This  affection  simply  consists  of  inflammation  and  sup- 
puration of  the  lining  membrane  of  a  tooth  affected  with 
exostoses,  and  the  enlargement  of  the  canal  passing 
through  its  root  by  the  corrosive  action  of  the  fluids 
therein  contained.] 

When  the  tooth  has  been  extracted,  I  have  usually 
found  the  membrane  sprouting  at  the  end  of  the  fang,  the 
internal  part  of  which  is  much  enlarged,  and  the  external 
part  has  a  rough,  scaly  appearance;  also,  during  the 
progress  of  this  disease,  the  body  of  the  tooth  changes  in 
appearance,  and  gradually  acquires  a  dark  colour. 

The  only  treatment  which  can  be  observed  here,  is  to 
scarify  the  gums  occasionally,  and  to  wash  the  mouth 
frequently  with  an  astringent  lotion :  for  this  purpose,  the 
infusion  of  roses  with  tincture  of  myrrh  is  very  beneficial. 
As  no  cure  of  this  complaint  can  be  expected,  the  extrac- 
tion of  the  tooth  should  be  recommended  as  soon  as  the 
gums  have  acquired  a  truly  diseased  appearance;  for,  if 
the  disease  be  allowed  to  take  its  natural  course,  the 
gums  become  so  extensively  affected  as  to  induce  absorp- 
tion of  the  alveolar  processes  belonging  to  the  neighbour- 
ing teeth,  which  is  followed  by  their  consequent  loss. 


CHAPTER    NINTH. 

OF    THE    REMOVAL    OF    THE    ENAMEL    BY    THE    DENUDING    PROCESS. 

This  is  a  disease  producing  a  change  in  the  teeth,  by 
which  they  acquire  an  appearance  unlike  that  of  caries, 
but  attended  with  a  loss  of  substance. 

The  tooth  does  not,  as  in  caries,  become  softer,  nor, 
like  that  disease,  does  it  originate  in  inflammation,  but  it 
consists  in  a  removal  of  the  enamel  from  the  bone  of  the 
tooth,  as  if  by  solution  and  gradual  abrasion. 

It  affects  the  incisores  much  more  frequently  than  any 
other  teeth,  and,  in  all  the  cases  which  I  have  seen,  its 
operation  is  limited  to  the  exterior  surface  of  the  teeth. 

The  first  appearance  is  in  the  enamel  of  one  or  more  of 
the  incisores  becoming  thinner,  and  appearing  as  if  a 
small  portion  had  been  scooped  or  filed  out,  occasioning 
a  slight  depression.  This  removal  of  the  enamel  con- 
tinues until  so  much  is  taken  away  as  to  leave  the  bone 
exposed:  as  this  denuding  process,  according  to  Mr. 
Hunter's  term,  advances,  the  tooth  changes  in  its  colour, 
gradually  becoming  yellower,  as  the  bony  part  is  more 
exposed.  When  the  whole  of  the  enamel  is  destroyed, 
part  of  the  bone  is  also  removed  :  the  remainder  acquires 
a  brownish  hue,  is  very  highly  polished,  and  will  often 
remain  in  this  state  for  a  number  of  years. 

T  have  seen  a  few  cases  in  which  the  teeth  have  been 
so  much  wasted,  as  to  have  all  the  anterior  part  removed  ; 


250  OF  THE  REMOVAL  OF  THE  ENAMEL 

but  yet  the  natural  cavity  has  not  been  exposed,  for  the 
bone  has  remained  in  a  prominent  line,  as  it  were  defend- 
ing that  particular  part,  and  thus  preventing  pain. 

Sometimes  teeth  thus  affected  become  tender,  very 
susceptible  of  cold,  and  are  made  uneasy  by.  the  use  of 
acids. 

It  is  difficult  to  make  a  very  good  engraving  of  this 
disease.  Fig.  3,  Plate  XVII.  is  designed  to  show  the 
common  and  early  appearance  of  it.  In  other  cases  there 
is  an  appearance  as  if  a  small  round  file  had  been  applied 
to  the  anterior  surface  of  the  teeth,  close  to  the  gums, 
removing  a  considerable  portion  of  them,  but  leaving  the 
surface  exceedingly  smooth. 

Fig.  4,  is  intended  to  describe  this  appearance  as 
extending  across  the  necks  of  all  the  incisores  of  both 
jaws.  In  these  cases  the  molares  participate  in  the  dis- 
ease. 

Fig.  5,  are  two  cuspidati,  in  which  are  very  great 
depressions,  as  if  made  by  a  round  file. 

I  am  not  able  to  assign  any  cause  for  this  loss  of  the 
enamel  and  part  of  the  substance  of  the  tooth,  especially 
as  it  is  confined  to  that  portion  of  the  teeth  which  could 
not  be  acted  upon  by  the  friction  of  one  tooth  against 
another.  I  have  observed  it  both  in  healthy  and  delicate 
persons.  As  it  appears  to  be  connected  with  some  cause 
which  may  produce  a  solution  of  the  enamel,  it  is  very 
possible  that  the  saliva  may  have  some  influence,  and  that 
the  friction  of  the  lips  may  contribute  to  the  removal  of 
the  enamel.  [The  editor  is  of  the  opinion  that  it  is  the 
result  of  the  action  of  the  mucous  secretions  of  the  mouth, 
which,  in  some  persons,  are  found  to  contain  more  septic 
acid  than  in  others.] 

The  only  means  to  prevent  a  rapid  progress  of  this 
disease,  is  to  avoid  whatever  may  contribute  to  it;  there- 


BY  THE  DENUNDING  PROCESS.        251 

fore,  as  all  acids  act  powerfully  upon  the  teeth,  their  use 
as  an  article  of  diet  should  be  forbidden :  and,  whenever 
there  is  any  necessity  for  employing  a  medicine  which 
contains  an  acid,  persons  should  be  extremely  careful  to 
rinse  the  mouth,  and  wipe  the  teeth  immediately  after- 
wards wTith  a  cloth.  [The  affection  may  oftentimes,  after 
it  has  made  some  progress,  be  arrested  by  plugging  the 
diseased  part.  Whenever  it  is  possible  to  form  a  suitable 
cavity  for  the  retention  of  the  filling,  this  can  always  be 
done.] 


CHAPTER    TENTH. 

OF    THE    WEARING    OF    THE   TEETH    BY    MASTICATION. 

The  mouths  of  some  persons  are  so  constructed,  and 
the  teeth  so  placed,  that,  when  the  jaws  are  closed,  the 
incisores,  not  being  so  long  as  they  usually  are,  meet  each 
other  at  the  cutting  edges.  Thus  a  variety  is  formed 
from  the  usual  mode,  which  is  for  the  incisores  of  the 
upper  jaw,  when  the  mouth  is  closed,  partially  to  overlap 
those  of  the  under  jaw. 

When  the  teeth  meet  in  the  manner  above  described, 
they  all  act  upon  each  other,  and  the  jaw  has  a  much 
more  extensive  lateral  motion.  This  occasions  greater 
friction  in  mastication,  by  which  the  teeth  gradually  wear 
away  a  part  of  each  other.  In  some  persons  they  become 
worn  dowrn  equally  all  around  the  mouth,  w hilst  in  others, 
who  have  acquired  a  habit  of  masticating  their  food  on 
one  side  only,  the  teeth  which  have  been  in  constant  use 
are  worn  down,  the  others  remaining  quite  perfect.  The 
same  circumstance  also  happens,  if  persons,  by  reason  of 
caries,  have  lost  several  teeth  in  the  early  part  of  life: 
those  which  have  remained  have  become  very  much 
worn  away.  I  have  seen  a  gentleman  whose  teeth  were 
so  much  worn  down  as  to  have  the  whole  of  the  crowns 
removed,  leaving  only  the  fangs  in  the  jaws  even  with  the 
edges  of  the  gums. 

It  is  not  unfrequent  for  teeth  in  this  state  to  become 


WEARING   OF  THE  TEETH  BY  MASTICATION.        253 

tender;  the  application  of  cold  or  acids  excites  consider- 
able pain,  but  this  generally  soon  subsides;  for,  during 
the  time  that  the  teeth  are  wearing  away  by  their  action 
upon  each  other,  a  process  goes  on  in  the  cavity,  by 
which  their  sensibility  is  destroyed ;  the  vessels  take  on 
a  new  action,  and  deposit  ossific  matter  until  the  whole 
cavity  is  completely  obliterated.  This  circumstance  also 
happens  very  frequently  in  the  teeth  of  old  people,  wrhich 
accounts  for  their  not  being  so  liable  to  the  tooth-ache. 


33 


CHAPTER    ELEVENTH. 

I 

OF    FRACTURES    OF    THE    TEETH. 

The  teeth  are  liable  to  be  fractured  by  blows,  which 
may  be  inflicted  either  by  accidents,  or  from  malicious 
intentions.  The  incisores  of  the  upper  jaw  are  the  most 
exposed  to  these  accidents:  boys,  in  their  various  amuse- 
ments, occasionally  receive  blows  in  the  mouth,  which 
not  unfrequently  occasion  fractures  of  the  front  teeth. 

In  falling  upon  the  face,  the  teeth  are  sometimes  struck 
against  a  stone;  in  throwing  of  stones  at  each  other,  one 
may  be  received  against  the  teeth ;  in  an  incautious  at- 
tempt to  catch  a  cricket  ball,  the  force  of  which  is  not 
sufficiently  spent,  it  may  come  with  violence  against  the 
mouth:  in  these,  and  other  similar  ways,  persons  are 
subjected  to  fractures  of  the  teeth;  also,  in  the  mastication 
of  food,  hard  substances,  such  as  splinter  of  bone,  or  a 
small  stone,  or  a  shot  in  game,  may  unexpectedly  be 
bitten  upon,  at  which  time  the  muscles  of  the  lower  jaw, 
being  in  very  strong  action,  exert  a  force  sufficiently  pow- 
erful to  fracture  a  perfectly  sound  tooth. 

The  treatment  of  these  cases  will  depend  much  upon 
the  extent  of  the  injury.  If  a  small  piece  be  broken  off 
from  the  point  of  a  tooth,  nothing  more  wrill  be  necessary 
than  with  a  fine  file  to  make  the  rough  edge  smooth. 

A  tooth  rarely  becomes  carious  in  consequence  of  an 
accident  of  this  kind;  for,  if  there  be  no  predisposition  in 


OF  FRACTURES  OF  THE  TEETH.       255 

a  tooth  to  decay,  the  mere  removal  of  a  small  portion  of 
it  will  not  cause  caries. 

A  fracture  of  a  tooth  occasions  inconvenience  in  pro- 
portion to  the  injury  done  to  the  cavity  of  the  tooth.  If 
it  should  extend  nearly  into  the  cavity,  having  left  only  a 
thin  piece  of  bone  to  cover  it,  the  person  will  be  subject 
for  some  time  to  pain  on  exposure  to  cold  air;  this,  how- 
ever, is  generally  cured  by  a  deposit  of  bone  taking  place 
within  the  cavity,  by  which  the  nerve  is  defended,  and 
the  tooth  may  remain  during  life  without  exciting  further 
trouble. 

If  the  fracture  should  extend  into  the  cavity,  the  mem- 
brane will  immediately  be  exposed,  and  inflammation  will 
follow.  In  this  case  the  treatment  must  be  regulated  by 
the  age  and  peculiar  circumstances  of  the  patient.  If  the 
accident  should  have  happened  to  a  youth  under  fifteen 
or  sixteen  years  of  age,  it  would  be  better  to  extract  the 
tooth,  because  the  teeth  on  each  side  will  gradually 
approach  each  other,  so  that  when  he  is  arrived  at  matu- 
rity the  loss  may  never  be  observed. 

It  is  to  be  understood  that  I  am  speaking  of  accidents 
occurring  to  the  permanent  teeth;  blows  received  by  chil- 
dren under  five  or  six  years  of  age  can  only  injure  the 
temporary  teeth;  sometimes  by  accidents  one  or  more  of 
these  are  beaten  out:  this  never  fails  to  produce  alarm  in 
the  minds  of  the  parents;  but,  as  in  a  short  time  a  remo- 
val of  those  teeth  must  have  been  affected  by  nature,  or 
performed  by  art,  it  cannot  be  considered  as  a  permanent 
injury. 

If  the  case  be  neglected  for  some  time,  the  inflamma- 
tion extends  to  the  fang  and  socket,  and  produces  a  con- 
siderable gum-boil,  which  can  only  be  cured  by  the 
extraction  of  the  tooth. 

When  an  accident  of  this  kind  occurs  to  a  person  more 


256  OF    FRACTURES    OF    THE    TEETH. 

advanced  in  years,  the  loss  is  very  considerable,  as  the 
appearance  of  the  mouth  and  also  the  speech  becomes 
thereby  much  affected. 

In  Plate  XVIII.  Fig.  9,  is  a  representation  of  two  cen- 
tral incisores  which  were  broken  by  a  fall.  Fig.  10,  is  the 
posterior  view  of  these  teeth,  the  fracture  of  which  will 
be  seen  extending  into  the  cavity. 

In  an  accident  of  this  kind  affecting  either  one  or  both 
teeth,  if  the  person  should  apply  for  assistance  immedi- 
ately after  the  accident,  and  before  any  inflammation  has 
supervened,  I  should  recommend  that  the  tooth  or  teeth 
be  extracted  with  great  care.  When  this  has  been  done, 
the  cavity  in  the  tooth  should  be  cleared  out  as  much  as 
possible,  and  some  gold-leaf  be  introduced,  so  as  com- 
pletely to  fill  it  up. 

After  the  cavity  has  been  thus  stopped,  the  teeth  are 
to  be  restored  to  their  sockets,  and  there  to  be  confined 
by  a  ligature;  they  will  soon  fix,  and  in  a  few  days  be  as 
secure  as  ever,  and  may  afterwards  remain  without  incon- 
venience for  a  great  number  of  years.  [The  editor  has 
found  this  treatment  to  succeed  only  in  the  fewest  number 
of  cases.  Teeth  after  having  been  removed  and  placed 
back  in  their  sockets,  are,  in  the  majority  of  instances,  at 
times,  more  or  less  troublesome.] 

If  the  fracture  of  a  tooth  should  be  so  great  as  in  Fig. 
1 1,  the  patient  must  submit  to  extraction:  or,  if  he  should 
be  desirous  to  preserve  the  appearance  of  his  mouth,  he 
may  be  recommended  to  have  the  remainder  of  the  tooth 
filed  away,  so  as  to  make  the  fang  even  with  the  gums, 
and,  in  the  manner  hereafter  to  be  described,  have  a  tooth 
fixed  to  the  fang  by  means  of  a  pivot.  [The  concussion 
of  a  blow  sufficiently  severe  to  fracture  a  tooth,  generally 
induces  inflammation  in  the  alveolo-dental  periosteal  tis- 
sue   and   renders  the    root  unfit   to   support  an  artificial 


OF  FRACTURES  OF  THE  TEETH.       257 

crown;  it  should  therefore  be  removed,  and  the  loss  of  the 
tooth  supplied  with  a  substitute  on  gold  plate  in  the  man- 
ner to  be  hereafter  described.  The  application  of  an  arti- 
ficial crown  to  such  a  root  has  been  known  to  be  produc- 
tive of  very  hurtful  consequences.  The  practice,  to  say 
the  least  of  it,  is  unscientific,  and  should  never  be  adopted, 
except  in  cases  of  the  most  absolute  necessity.] 

When  a  blow  has  been  received  upon  a  tooth  so  as  to 
loosen  it,  if  the  person  be  young,  it  will  become  fast 
again;  but  it  gradually  loses  the  whiteness  of  its  colour, 
and  at  length  acquires  a  bluish  tinge.  [This  is  owing  to 
the  destruction  of  the  vitality  of  the  organ,  resulting  from 
inflammation  and  suppuration  of  the  lining  membranes.] 

When  the  like  accident  occurs  to  a  person  rather 
advanced  in  life,  a  disease  usually  takes  place  about  the 
fang,  which  eventually  affects  the  socket;  the  tooth  then 
becomes  very  loose,  and  must  be  extracted. 

A  young  gentleman  had  the  central  incisores  broken  by 
a  cricket  ball,  as  represented  in  Fig.  9.  The  fracture  did 
not  extend  into  the  cavity.  In  this  case  the  teeth  were 
filed  so  as  to  remove  the  irregular  portion,  and  bring 
them  as  nearly  as  possible  into  a  line  with  the  other  teeth. 

Fig.  10  represents  a  posterior  view  of  the  central  inci- 
sores of  a  young  gentleman,  who,  falling  on  his  face, 
struck  his  mouth  against  a  stone.  So  much  of  the  teeth 
were  broken  off  as  to  uncover  the  membrane;  the  en- 
trance into  the  cavity  is  described  by  the  dark  spots,  a  a. 
Immediately  after  the  accident,  the  mere  touch  of  the 
tongue  passing  over  the  exposed  part  of  the  membrane 
occasioned  extreme  pain;  in  a  short  time,  inflamma- 
tion extended  to  the  socket,  the  lip  became  very  much 
swollen,  and  a  considerable  quantity  of  matter  was  formed. 
The  parents,  being  very  desirous  to  preserve  the  teeth, 
made  use  of  every  means  to  abate  the  inflammation;  but, 


258       OF  FRAC TURKS  OF  THE  TEETH. 

as  the  gums  remained  thickened,  and  the  discharge  of 
matter  continued,  they  were  at  length  obliged  to  consent 
to  the  extraction  of  the  teeth:  on  examining  the  fangs, 
they  were  found  covered  with  a  considerable  quantity  of 
lymph,  which  is  a  common  consequence  of  a  neglected 
accident  of  this  description. 

In  Fig.  1 1  is  the  representation  of  the  teeth  of  a  young 
gentleman  who  had  the  central  incisores  broken  by  a 
blow  of  a  stick:  being  anxious  to  have  the  deformity 
removed  in  the  best  possible  manner,  he  was  willing  to 
submit  to  any  means  that  should  be  recommended.  J 
stated  to  him  the  necessity  of  preserving  the  fangs  for  the 
purpose  of  fixing  other  teeth  in  a  permanent  manner; 
but,  perceiving  that  the  sensibility  of  the  exposed  mem- 
brane was  very  great,  I  concluded  that  he  would  not  be 
able  to  endure  the  pain  attendant  on  the  common  mode 
of  destroying  the  nerve,  therefore  determined  to  extract 
the  teeth  partially,  and  return  them  back  into  the  socket; 
after  which  I  introduced  an  instrument,  and  passed  it  up 
to  the  extremities  of  the  fangs,  without  occasioning  the 
least  painful  sensation.  Union  of  the  fangs  to  the  socket 
took  place  in  a  few  days,  when  the  remainder  of  the 
crowns  of  the  teeth  was  filed  away,  and  other  teeth  fixed. 

If  a  blow  be  inflicted  with  sufficient  violence  to  remove 
a  tooth  from  its  socket,  it  may  be  returned  again;  and,  if 
secured  to  the  other  teeth  by  a  ligature,  it  will  become 
fast  in  a  few  days.  I  have  known  a  case  in  which  a 
tooth  had  remained  out  of  the  socket  for  six  hours,  and 
yet,  when  returned,  became  again  perfectly  united.  It 
will  be  necessary  when  a  tooth  has  been  out  of  the  socket 
for  some  time,  to  introduce  a  probe,  and  remove,  the 
coagulated  blood;  the  fang  may  then  be  inserted  with 
ease,  and  inflammation  will  be  avoided.  But  when  the 
teeth  have  been  loosened  or  beaten  out  by  a  blow,  and 


OF  FRACTURES  OF  THE  TEETH.       259 

the  alveolar  processes  have  been  injured,  or  fractured, 
the  teeth  will  never  become  perfectly  fast;  inflammation 
arises,  and  nothing  but  extraction  will  effect  the  cure. 

[We  think  it  doubtful  whether  the  replacement  of  a 
tooth,  which  has  been  fo:cibly  thrust  from  its  socket,  is 
strictly  proper  under  any  circumstances,  yet  necessity 
may  sometimes  seem  to  justify  it.  We  have  never  known 
a  tooth  thus  replaced  to  become  so  perfectly  re-united  as 
not,  occasionally,  to  be  productive  of  disturbance  to  the 
surrounding  parts,  and  ultimately  to  cause  a  thickening  of 
the  periosteum  of  the  alveolus.] 


CHAPTER    TWELFTH. 

OF    THE    DISEASES    OF    THE    GUMS. 

The  alveolar  processes  of  both  jaws  are  covered  by  a 
substance  which  is  called  the  gums.  They  have  a  semi- 
cartilaginous  hardness,  are  very  vascular,  and  possess 
considerable  contractability.  Under  slight  inflammation, 
occasioned  by  cold,  they  become  thickened,  enlarged,  and 
swollen,  and  of  a  loose,  spongy  texture. 

The  gums  adhere  to  the  necks  of  the  teeth,  and  pass 
between  each  of  them,  being  attached  to  the  bony  parti- 
tions of  the  alveolar  processes,  by  which  the  inner  and 
outer  gums  are  connected  together. 

When  the  gums  are  in  a  healthy  state,  they  are  firmly 
attached  to  those  parts  of  the  teeth  which  are  not  contained 
in  the  sockets,  and  their  extreme  edges  lie  upon  the 
enamel.  The  gums,  which  are  between  the  teeth  in  the 
upper  jaw,  descend  lower;  and,  in  the  under  jawT,  are 
situated  higher  than  the  other  parts:  hence,  at  the  necks 
of  the  teeth,  they  form  an  arched  appearance.  Naturally, 
they  do  not  possess  much  sensibility,  and  therefore  are 
not  injured  by  the  friction  which  is  unavoidably  occa- 
sioned by  the  mastication  of  hard  substances;  but,  when 
inflamed,  they  acquire  such  extreme  sensibility,  that 
even  the  pressure  of  the  cheek  causes  pain. 

In  infancy,  during  the  progress  of  dentition,  should 
there  be  inflammation  of  the  gums,  the  slightest  touch 


OF    THE    SCURVY    IN    THE    GUMS.  261 

produces  so  much  suffering,  that  children  will  even  refuse 
the  breast,  on  account  of  the  pain  attending  the  necessary 
pressure  of  the  nipple.  On  the  contrary,  when  there  is 
no  inflammation,  the  gums  are  so  insensible,  that  they 
are  pleased  with  sucking  or  biting  a  hard  crust.  In  old 
age,  when  there  are  no  teeth,  the  gums  possess  so  little 
sensibility,  that  the  biting  or  bruising  of  food  is  attended 
with  no  pain ;  and  it  is  remarkable,  that  those  who  have 
lost  all  their  teeth  enjoy  their  food  much  more  than  those 
who  have  only  a  few  weak  ones  left. 

Several  affections  of  the  gums  originate  from  diseases 
of  the  teeth,  but  there  are  others  peculiar  to  the  gums 
themselves:  I  shall  first  describe  those  diseases  which 
arise  from  the  teeth. 


OF  THE  SCURVY  IN  THE  GUMS. 

The  most  common  disease  of  the  gums,  is  that  which 
has  been  usually  called  scurvy  in  the  gums,  thus  denomi- 
nated from  assuming  an  appearance  similar  to  that  which 
happens  to  persons  afflicted  with  the  sea-scurvy. 

[But  this  affection  is  wholly  unlike  that,  and  although 
favoured  and  aggravated  by  a  scorbutic  diathesis  of  the 
general  system,  it  often  occurs  in  individuals,  in  whom 
there  exists  not  the  slightest  tendency  to  that  disease.] 

This  disease  is  generally  marked  by  the  gums  becom- 
ing redder  than  ordinary,  and  enlarged  from  a  tumes- 
cence of  the  vessels,  which  are  made  to  bleed  by  the 
slightest  causes,  such  as  the  use  of  a  tooth-brush,  the 
biting  of  a  crust,  or  even  by  only  sucking  them. 

If  the  complaint  be  not  attended  to  in  this  stage,  the 
gums  become  very  soft  and  spongy,  and  shortly  after- 
wards they  are  affected  with  considerable  soreness,  being 
so  tender  as  scarcely  to  allow  the  mastication  of  food; 
34 


262  OF    THE    SCURVY    IN    THE    GUMS. 

this  is  often  followed  by  a  discharge  of  matter  at  the 
necks  of  the  teeth;  and  an  exulceration  may  be  observed 
on  the  edges  of  the  gums  between  the  teeth;  also  those 
parts  which  form  the  arched  appearance  are  soon  de- 
stroyed, so  that  the  gums  have  a  uniform  straightness, 
and  the  necks  of  the  teeth  are  consequently  uncovered. 

This  disease  next  proceeds  to  the  alveolar  processes, 
the  substances  of  which  are  destroyed  by  absorption;  at 
length  the  teeth  become  loose,  and,  in  a  few  years,  drop 
out,  one  after  the  other,  at  short  intervals,  until  the  per- 
son is  rendered  toothless. 

It  is  from  this  complaint  that  many  persons  lose  their 
teeth  at  a  very  early  period  of  life;  indeed,  most  individ- 
uals are  more  or  less  subject  to  it,  as  the  gums,  in  some 
part  or  other,  although  there  be  no  disease  of  the  teeth, 
are  liable  to  become  preternaturally  red,  enlarged,  or 
tender:  whenever,  therefore,  a  tendency  to  this  disease 
is  observed,  great  care  should  be  taken  to  apply  such 
means  as  will  arrest  its  progress.  At  its  commencement 
it  is  very  manageable,  and  may  always  be  relieved  by 
puncturing,  with  the  point  of  a  lancet,  those  parts  which 
appear  unnaturally  red  or  distended.  The  loss  of  blood 
affords  immediate  relief;  and  whenever  the  slightest 
soreness,  or  an  increased  fulness  of  the  gums  is  perceived, 
the  above  plan  of  scarifying  the  vessels  will  be  found 
highly  beneficial.  Suppose  the  disease  to  have  proceed- 
ed to  that  stage  in  which  the  gums  become  spongy  or 
loose  in  texture  the  lancet  should  be  then  used  with 
greater  freedom.  Essential  service  is  always  derived 
from  the  loss  of  blood:  in  some  cases  the  use  of  leeches, 
as  drawing  away  a  larger  quantity  of  blood,  is  attended 
with  the  best  effects.  Frequent  recourse  should  be  had 
to  this  treatment,  which  may  be  accompanied  with  the 
use  of  astringent  lotions,  such  as  the  infusion  of  roses 


OF    THE    SCURVY    IN    THE    GUMS.  263 

with  the  tincture  of  myrrh,  decoction  of  bark,  solutions  of 
alum,  arquebusade  water,  &c.  In  these  cases  great 
benefit  is  derived  from  the  use  of  sea-water,  and  there- 
fore I  always  recommend  it,  whenever  it  can  be  pro- 
cured; adding,  that,  if  the  gums  be  tender,  it  should  be 
used  warm.  In  all  cases  where  there  is  a  tendency  to 
inflammation  of  the  gums,  arising  from  this  disease,  much 
is  to  be  expected  from  the  free  use  of  a  tooth-brush;  at 
first  the  gums  are  apt  to  bleed  a  little,  by  which  the  same 
benefit  is  obtained  as  from  the  lancet:  by  degrees,  the 
gums  become  more  firm,  and  at  length  a  hard  brush  may 
be  used  without  causing  any  loss  of  blood,  or  giving  the 
slightest  pain. 

When  the  gums  are  exceedingly  tender,  and  have  the 
smallest  tendency  to  exulceration,  the  patient  should  be 
directed  to  wash  the  mouth  very  frequently  with  barley 
water  sweetened  with  honey :  in  two  or  three  days,  if  the 
soreness  should  be  diminished,  the  lancet  should  be 
cautiously  used,  accompanied  with  diluted  tincture  of 
myrrh,  as  a  wash. 

If  the  edges  of  the  gums  do  not  heal  under  this  treat- 
ment, and  if  they  should  hang  loosely  about  the  necks  of 
the  teeth,  much  good  will  be  derived  from  the  use  of  the 
argentum  nitratum  in  solution.  If  the  disease  be  only 
partial,  the  caustic  should  be  applied  with  a  camePs  hair 
pencil  dipped  in  the  solution.  This  remedy  appears  to 
communicate  a  new  action  to  the  gums,  and  they  generally 
get  well  in  a  short  time.  Indeed,  whenever  the  gums 
are  very  full,  and  discharge  a  good  deal  of  offensive  mat- 
ter, washing  the  mouth  with  a  solution  of  lunar  caustic  is 
a  very  excellent  remedy  for  rendering  the  mouth  sweet 
and  comfortable. 

When  this  is  applied  to  the  sore  edges  of  the  gums 
with  the  hair  pencil,  it  may  be  used  as  strong  as  in  the 


264  OF    THE    SCURVY    IN    THE    GUMS. 

proportion  of  a  drachm  to  an  ounce  of  water;  but,  if  the 
mouth  be  rinsed  with  it,  it  ought  not  to  exceed  the  pro- 
portion of  one  grain  to  two  ounces  of  water;  because,  if 
it  get  into  the  fauces,  it  is  liable  to  produce  an  unpleasant 
nausea. 

Persons  who  are  subject  to  inflammation  of  the  gums, 
should  have  them  scarified  whenever  they  become  painful, 
or  are  more  turgid  than  usual.  By  the  loss  of  a  little 
blood,  they  are  instantly  relieved,  and  the  disease  is  thus 
prevented  from  proceeding  to  the  extent  which  has  been 
described. 

In  scarifying  the  gums,  the  lancet  should  be  applied 
longitudinally  to  those  parts  which  are  situated  between 
the  te^eth,  because,  if  the  gums  are  cut  in  those  parts 
where  they  cover  the  fangs,  they  will,  in  healing,  retire, 
and  leave  the  necks  of  the  teeth  exposed;  whereas,  if 
they  are  lanced  in  the  angles,  between  the  teeth,  they 
will  in  healing  be  drawn  tighter,  and  the  teeth  will  even- 
tually be  strengthened. 

[Although  favoured  by  certain  constitutional  tendencies, 
the  immediate  cause  of  inflammation,  and  sponginess  of 
the  gums,  is  local  irritation,  and  the  removal  therefore  of 
every  thing  from  the  mouth  which  can  act  as  irritants 
upon  this  structure,  constitutes  the  first  curative  indica- 
tion. If  there  be  any  dead  teeth  in  the  mouth,  or  roots 
of  teeth,  or  teeth  which  from  their  peculiar  position  act 
as  irritants  to  the  gums  or  alveolar  periosteal  tissues, 
they  should  be  removed;  also  all  loose  teeth  which  from 
the  partial  destruction  of  their  sockets  cannot  regain  their 
lost  firmness,  as  well  as  all  tartar  or  other  extraneous 
matter  that  may  have  collected  around  or  on  the  teeth. 
This  should  constitute  the  first  step  in  the  treatment  of 
spongy  and  inflamed  gums,  and  in  addition  to  which,  the 
gums  should  be  lanced  in  the  manner  as  directed  by  the 


PRETERNATURAL    GROWTH    OF    THE    GUMS.      265 

author,  the  mouth  too,  should  be  gargled  several  times  a 
day  with  some  astringent  lotion.  In  the  mean  time  the 
most  constant  attention  should  be  paid  to  the  cleanliness 
of  the  teeth.  They  should  be  thoroughly  cleansed  with  a 
good  brush  and  waxed  floss-silk,  four  or  five  times  every 
day.  The  observance  of  this  last  is  indispensable,  and  if 
it  be  neglected,  no  matter  how  appropriate  the  other 
treatment  may  be,  it  will  be  found  inefficient  and  fail  to 
accomplish  a  cure. 

As  a  gargle,  the  editor  has  found  nothing  better  than  a 
strong  decoction  of  the  inner  bark  of  young  green  white 
oak  prepared  as  directed  by  Dr.  Fitch,  by  taking  two 
pounds,  putting  it  into  six  quarts  of  water  and  boiling  it 
down,  until  it  becomes  strongly  impregnated  with  the 
bark,  which  last  is  then  to  be  taken  out,  and  the  water 
boiled  down  to  two  quarts,  strained,  and  put  in  a  bottle 
for  use.  The  following,  recommended  by  Dr.  Koecker, 
is  also  a  very  excellent  gargle.  Take  of  honey  and  the 
tincture  of  rhattania  two  ounces  each,  mix  and  dilute  in 
the  proportion  of  three  table-spoonfuls  to  a  pint  of  warm 
sage  tea  or  water,  to  be  used  frequently  through  the  day. 

But  should  matter  be  discharged  from  between  the 
gums  and  necks  of  the  teeth,  notwithstanding  the  use  of 
the  foregoing  remedies,  a  solution  of  the  nitrate  of  silver, 
as  recommended  by  the  author,  should  be  employed.  It 
is  also  sometimes  necessary  to  have  recourse  to  constitu- 
tional treatment,  which  should  accord  with  the  peculiar 
indications  of  the  case.] 

OF  PRETERNATURAL  GROWTH  OF  THE   GUMS. 

Decayed  teeth  are  sometimes  the  cause  of  deranged 
action  in  the  arteries  of  the  gums,  by  which  they  become 
so  enlarged  a§Lto  form  excrescences  or  tumours  of  con- 


266        PRETERNATURAL    GROWTH   OF    THE    GUMS. 

siderable  size.  These  are  frequently  the  consequence  of 
carious  stumps,  and  are  produced  in  the  following  manner. 
The  crown  of  a  tooth  having  been  removed  by  caries, 
and  the  stump  remaining  in  the  socket,  even  with  the 
gums,  if  the  socket  do  not  close  at  the  bottom,  so  as  to 
cause  a  protrusion  of  the  stump,  it  is  so  much  wasted 
away,  that  the  edges  of  the  gums  have  a  tendency  to 
grow  over  it.  When  the  gum  has  thus  partially  grown 
over  a  ragged  stump,  it  is  liable  to  become  very  sore  and 
inflamed,  from  the  constant  irritation  which  the  gum  suf- 
fers from  being  pressed  upon  the  sharp  edge  of  the 
stump.  Hence  a  diseased  action  is  caused,  and  the  gum 
very  rapidly  increases  in  size.  I  have  seen  an  enlarge- 
ment of  this  kind,  surrounding  some  stumps  in  the  lower 
jaw,  equal  to  the  size  of  a  walnut.  In  these  cases  no 
cure  can  be  expected  whilst  the  cause  is  permitted  to 
continue;  the  first  thing,  therefore,  to  be  done  is,  to 
extract  the  stumps,  which  in  general  effects  all  that  can  be 
desired;  the  enlargement  of  the  gums  being  of  a  soft, 
spongy,  and  fungous  nature,  is  always  reduced  by  the 
hemorrhage  which  attends  this  operation,  after  which,  the 
cause  of  irritation  being  removed,  the  vessels  contract, 
and  the  gums  acquire  their  natural  state. 

Some  time  since,  Mr.  Cooper  was  applied  to,  by  a 
lady  who  had  an  enlargement  of  the  gums  in  the  lower 
jaw,  which  nearly  filled  up  one  side  of  the  mouth;  there 
were  several  decayed  stumps  remaining,  around  which 
this  enlargement  of  the  gums  had  taken  place.  Mr. 
Cooper  sent  her  to  me  for  the  purpose  of  extracting  the 
stumps,  intending,  when  these  had  been  removed,  to 
extirpate  the  tumour.  The  stumps  being  imbedded  in 
the  gums,  the  operation  was  unavoidably  attended  with 
laceration  of  the  excrescence,  and  consequently  a  con- 
siderable hemorrhage.     A  few  days  afterwards  the  tumour 


PRETERNATURAL  GROWTH  OF  THE  GUMS.   267 

became  very  flaccid  and  dark  coloured,  it  then  sloughed 
away  in  large  pieces,  so  that  a  cure  was  effected  without 
any  other  operation. 

Sometimes  tumours  arise  from  the  gums  without  there 
being  any  diseased  tooth,  or  any  evident  cause:  these 
are  of  a  much  firmer  texture  than  those  above  described, 
frequently  being  of  the  same  consistence  as  the  gums, 
when  in  a  healthy  state. 

They  are  very  vascular,  and  the  treatment  has  always 
been  considered  as  extremely  troublesome:  the  usual 
mode  adopted  for  removing  them  has  been  that  of  exci- 
sion; this  operation  has  generally  been  attended  with  a 
great  loss  of  blood,  to  stop  which,  as  Mr.  Hunter  observes, 
"it  is  often  necessary  to  apply  the  actual  cautery,  for 
arteries  going  to  increased  parts  are  themselves  increased, 
and  also  become  diseased,  and  have  not  the  contractile 
power  of  a  sound  artery."  A  great  hemorrhage  from 
the  gums,  or  any  part  of  the  mouth,  must  always  be 
regarded  as  alarming,  on  account  of  the  impossibility  of 
discovering  and  securing  any  principal  branch  of  the 
artery;  or,  if  the  bleeding  should  be  from  a  number  of 
small  vessels,  the  difficulty  of  applying  pressure  with 
advantage  is  so  very  great,  that  recourse  must  always  be 
had  to  more  powerful  agents.  Mr.  Hunter  also  remarks, 
that  these  excrescences  are  liable  to  grow  again,  after  the 
operation  of  excision;  and  mentions,  that  they  have  been 
removed  six  times,  and  have  as  often  been  reproduced ; 
which  he  attributes  to  a  cancerous  disposition.  On  these 
accounts,  I  determined  some  years  since,  that,  if  any 
cases  of  this  kind  should  ever  come  under  my  care,  I 
would  attempt  their  removal  by  means  of  ligatures.  The 
first  case,  in  which  I  was  consulted,  was  a  lady  of  about 
forty  years  of  age,  who  had  several  of  the  teeth  on  the 
right  side  of  the  upper  jaw  extracted  when  she  wras  a 


268   PRETERNATURAL  GROWTH  OF  THE  GUMS. 

young  woman:  about  five  years  before  I  saw  her,  the 
gums,  covering  the  jaw  where  the  teeth  had  been  situated, 
appeared  to  be  thicker  than  before;  they  gradually 
increased  in  size  until  a  very  large  tumour  was  formed: 
it  had  now  become  so  large  as  to  affect  the  speech,  and 
in  other  ways  was  extremely  troublesome. 

The  lady  was  very  desirous  to  have  it  removed;  to 
effect  which,  without  incurring  the  danger  of  hemorrhage, 
I  employed  ligatures.  The  basis  being  very  broad,  I 
passed  a  needle,  with  two  ligatures,  close  to  the  jaw 
bone,  through  the  substance  of  the  tumour,  half  of  which 
was  then  included  in  each  ligature.  The  ligatures  were 
tied  just  tight  enough  to  stop  the  circulation;  the  next 
day  there  was  a  great  deal  of  inflammation,  which  sub- 
sided in  proportion  as  the  ligatures  began  to  produce 
ulceration,  which  on  the  fourth  day  was  very  considera- 
ble: new  ligatures  were  then  applied;  on  the  sixth  day 
these  were  removed  and  others  introduced;  on  the  eighth, 
one  ligature  came  away,  leaving  the  tumour  hanging  only 
by  a  small  pedicle;  this  being  cut  through  with  a  lancet, 
the  whole  was  removed;  the  surface  was  then  touched 
w7ith  some  diluted  nitrous  acid,  and  the  gums  have  ever 
since  continued  in  a  perfectly  healthy  state. 

Subsequent  experience  has  furnished  me  with  many 
opportunities  of  removing  several  excrescences  of  a  simi- 
lar nature.  The  basis  of  these  are  generally  very  broad, 
and  therefore  cannot  be  included  in  a  single  ligature;  on 
this  account,  I  have  commonly  passed  a  needle,  armed 
with  two  ligatures,  through  the  middle  part  of  the  tumour, 
as  close  to  the  bone  as  possible,  and  then  have  included 
half  of  the  substance  in  each  of  the  ligatures.  The  ulce- 
rated process  goes  on  here  very  quickly;  in  some  cases 
the  application  of  a  second  ligature  has  been  quite  suffi- 
cient, and  in  most  cases  it  has  not  been  necessary  to  make 
use  of  more  than  three  or  four  ligatures. 


PRETERNATURAL    GROWTH    OF    THE    GUMS.     269 

Last  summer,  a  lady  applied  to  Mr.  Cline,  having  an 
enlargement  of  the  gums  on  one  side  of  the  upper  jaw; 
a  tumour  of  very  large  size  was  formed,  which  pressed 
the  cheek  so  much  out  as  to  give  the  appearance  of  a 
swelled  face.  The  teeth  were  still  remaining,  and  not 
decayed;  but  the  molares  were  so  surrounded  with  the 
excrescence  of  the  gums,  that  no  successful  attempt  could 
be  made  to  extirpate  it  until  they  had  been  removed. 
Mr.  Cline  sent  the  lady  to  me  for  that  purpose,  I  ex- 
tracted the  farthest  tooth;  the  hemorrhage  being  rather 
profuse,  the  extraction  of  the  second  was  deferred;  two 
or  three  weeks  afterwards,  I  removed  the  second  molaris; 
at  the  time  the  excrescence  had  become  completely  altered 
in  form,  being  more  dependant,  and  after  the  second 
tooth  was  extracted,  it  contracted  at  the  basis  and  ac- 
quired a  pyriform  shape;  this  afforded  a  very  favourable 
opportunity  for  its  removal  by  ligature,  which  Mr.  Cline 
performed. 

There  are  other  excrescences  which  sometimes  form 
upon  the  gums,  differing  in  appearance  from  either  of  the 
former;  they  are  soft,  exceedingly  red,  and  very  liable  to 
bleed.  These  originate  from  some  diseased  state  of  the 
jaw  bone,  and  can  only  be  cured  by  the  removal  of  such 
disease.  It  has  most  commonly  happened  that  surgeons 
have  not  sufficiently  regarded  the  cause  of  the  disease; 
for,  simply  attending  to  the  state  of  the  gums,  they  have 
cut  off  these  fungous  excrescences  with  the  knife,  or 
burnt  them  with  caustic;  but  having  been  foiled  in  their 
various  attempts,  by  their  speedy  renewal,  they  have 
considered  them  as  cancerous,  and  the  patient  has  been 
rendered  extremely  unhappy  by  having  been  thus  in- 
formed. 

Sometimes  these  fungi  of  the  gums  arise  from  a  dis- 
eased  state  of  the  fangs  of  a  tooth,  which   fangs  have 
35 


270   PRETERNATURAL  GROWTH  OF  THE  GUMS. 

caused  a  death  of  part  of  the  alveolar  processes,  and  a 
consequent  diseased  state  of  the  gums.  In  these  cases, 
the  first  thing  to  be  done  is  to  extract  the  tooth  more 
particularly  connected  with  the  disease  of  the  gums,  an 
opportunity  is  then  given  to  examine  the  state  of  the 
alveolar  processes;  if  these  are  found  to  be  in  any  way 
diseased,  means  must  be  used  to  hasten  the  process  of 
exfoliation.  If,  on  examining  with  a  probe,  the  socket 
should  be  found  to  be  rough,  or  in  any  way  denuded  of 
its  periosteum,  then  a  dossil  of  lint,  dipped  in  a  weak 
solution  of  nitrous  acid,  should  be  applied  two  or  three 
times  a  day;  this  will  hasten  the  exfoliation  of  the  bone, 
and  produce  a  cure  of  the  gums. 

The  strength  of  this  lotion  should  be  one  drop  of  ni- 
trous acid  to  an  ounce  of  water. 

A  very  extraordinary  case  of  tumour  arising  from  the 
lower  jaw,  was  admitted  into  Guy's  Hospital  on  the  9th 
of  April,  1812.  The  patient's  name  Sarah  Dulwich,  aged 
13,  of  a  scrofulous  constitution.  The  tumour  was  situated 
under  the  left  cheek.  It  appeared  first  about  twelve 
months  ago  as  a  small  tumour  from  the  gums  of  the  lower 
jaw.  At  the  time  of  her  admission  into  the  Hospital,  the 
tumour  was  globular,  and  occupied  the  whole  of  the  left 
cheek.  Under  the  integuments  it  was  irregular,  and 
projected  below  the  jaw;  it  extended  to  the  cuspidatus 
of  the  right  side  irregularly  under  the  tongue,  which  it 
thrust  close  to  the  right  cheek.  The  surface  was  very 
irregular,  and  it  felt  hard  in  substance. 

The  pressure  of  the  teeth  of  the  upper  jaw  had  caused 
a  superficial  ulceration,  from  whence  there  was  occa- 
sionally an  offensive  discharge.  Viewed  externally  it 
reached  from  the  fore  part  of  the  chin,  passing  up  by  the 
side  of  the  left  nostril,  to  the  edge  of  the  left  orbit,  and 
thence  round  to  the  ear.     The  nose  was  pushed  consid- 


PRETERNATURAL  GROWTH  OF  THE  GUMS.   271 

erably  to  the  right  side,  thereby  occasioning  a  great 
distortion  of  the  countenance.  In  size  it  was  nearly  half 
that  of  the  head.  The  skin  over  the  whole  surface  had 
a  slight  blush  on  it,  and  the  veins  appeared  to  be  con- 
siderably enlarged.  She  complained  of  pain  at  the  back 
part  of  the  tumour,  and  there  was  some  suppuration  from 
the  right  ear.  Mastication  had  become  very  difficult  and 
painful,  in  consequence  of  the  pressure  of  the  teeth  on 
the  left  side  of  the  upper  jaw  upon  the  tumour  as  it  arose 
from  the  lower  jaw.  From  the  pressure  of  the  tumour, 
the  teeth  of  the  left  side  of  the  upper  jaw  were  pushed 
towards  the  opposite  side  of  the  mouth,  as  were  also  the 
teeth  of  the  lower  jaw.  In  other  respects  this  poor  girl 
was  in  good  health,  and  had  a  good  appetite. 

Before  the  disease  appeared,  she  was  subject  for  some 
months  to  the  tooth-ache  in  the  two  molares  of  the  lower 
jaw,  which  were  exceedingly  carious,  and  from  the  gums 
of  which  teeth  this  tumour  sprang. 

When  she  was  first  received  into  the  Hospital  the  jaws 
were  separated  nearly  an  inch  from  each  other  by  reason 
of  the  projection  of  the  tumour  from  the  back  to  the  fore 
part  of  the  mouth.  It  was  with  difficulty  the  lips  could 
be  brought  together,  but  in  the  common  state  they  sepa- 
rated to  at  least  an  inch  and  a  half  distance. 

The  tumour  continues  to  increase  rapidly,  and  by 
degrees  it  becomes  more  protruded  from  the  mouth. 
The  ulceration  on  the  surface  becomes  much  more  exten- 
sive. In  about  six  months  from  her  admission,  it  had 
become  so  exceedingly  enlarged  as  to  project  considera- 
bly beyond  the  lips,  which  were  extended  to  an  almost 
incredible  degree.  At  this  time  her  only  mode  of  taking 
nourishment  is  by  sucking  fluids  through  a  tube,  and  she 
is  gradually  becoming  exceedingly  emaciated. 

Besides  these  various  affections  of  the  gums,  they  are 


272   PRETERNATURAL  GROWTH  OF  THE  GUMS. 

subject  to  diseased  appearances,  symptomatic  of  constitu- 
tional disease.  Children  of  scrofulous  habits  are  more 
particularly  liable  to  a  spongy  state  of  the  gums,  accom- 
panied with  great  fetor  of  the  breath;  they  become  ulcer- 
ated so  as  to  cause  the  alveolar  processes  and  fangs  of  the 
teeth  to  be  exposed.  When  this  disease  occurs  to  chil- 
dren^ the  teeth  which  are  thus  affected  are  only  the  tem- 
porary teeth,  and  therefore  the  removal  of  these  is  not 
attended  with  any  permanent  disadvantage.  I  have 
always  considered  it  right,  whenever  any  ulceration  has 
taken  place  about  the  gums  of  children,  to  extract  the 
teeth,  and  I  have  usually  found  that  this  plan  has  com- 
pletely arrested  the  progress  of  the  disease :  at  the  same 
time  the  general  health  of  the  patient  should  not  be 
neglected,  and  the  appearance  of  the  gums  must  only  be 
considered  as  indicative  of  constitutional  derangement. 

Fig.  1,  Plate  XX.  represents  all  the  alveolar  processes 
of  the  under  jaw,  which  exfoliated  in  consequence  of  a 
neglected  disease  of  the  gums,  in  a  child  of  scrofulous 
habit.  It  was  given  me  by  Mr.  Goldston,  surgeon,  of 
Bath.  Similar  exfoliations  sometimes  take  place  in  con- 
sequence of  fever. 

In  more  advanced  age,  the  gums  are  also  symptomat- 
ically  affected :  I  once  saw  a  lady,  who  laboured  under 
general  weakness,  whose  gums  were  so  relaxed  and 
devoid  of  vital  energy,  as  to  be  perfectly  soft,  of  a  livid 
colour,  and  apparently  quite  dead.  I  pared  off  a  great 
quantity  of  them,  and  ordered  a  stimulating  lotion;  which 
with  attention  to  the  general  health,  and  change  of  situ- 
ation, sea  air,  &,c.  effected  a  cure. 

[The  whole  substance  of  the  gums  all  the  way  round, 
and  of  both  jaws,  are  sometimes  affected  with  a  morbid 
growth,  by  which  the  crowns  of  the  teeth  become  com- 
pletely imbedded  in  them.     When  in  this  condition  they 


PRETERNATURAL    GROWTH    OF    THE    GUMS.        273 

are  exceedingly  sensitive  to  the  touch  and  bleed  from  the 
slightest  injury.  This  peculiar  affection,  although  first 
excited  by  local  irritation,  is  determined  by  a  bad  habit 
of  body.  Scorbutic  and  scrofulous  dispositions  are 
more  subject  to  it  than  any  other. 

The  proper  treatment  in  cases  of  this  sort,  consists  in 
removing  all  that  portion  which  has  grown  over  the 
crowns  of  the  teeth,  and  all  dead  and  loose  teeth,  roots 
of  teeth,  and  teeth  so  badly  affected  with  caries  as  to 
render  their  restoration  to  health  impossible.  The  mouth 
should  be  gargled  several  times  every  day,  with  a  decoc- 
tion of  oak  bark,  prepared  as  before  directed ;  also  with  a 
solution  of  the  chloride  of  soda,  for  the  purpose  of  cor- 
recting the  fetor  of  the  mouth.  The  margins  of  the 
gums  should  at  the  same  time  be  occasionally  touched 
with  a  solution  of  the  nitrate  of  silver.  In  addition  to 
which,  such  general  treatment  should  be  adopted,  as  may 
be  indicated  by  the  state  of  the  constitutional  health. 

Temporizing  treatment  in  this  form  of  diseased  gums 
will  never  answer.  To  be  successful,  a  decided  impres- 
sion must  be  made  at  once.  The  treatment  must  be 
thorough.  It  is  not  sufficient  to  remove  all  dead  and  loose 
teeth,  and  the  roots  of  decayed  teeth.  The  morbid 
growth  of  the  gums  which  encase,  as  it  wTere,  the  crowns 
of  the  teeth,  should  be  removed  by  means  of  a  horizontal 
incision  on  a  line  near  the  termination  of  the  enamel;  in 
addition  to  this,  they  should  be  frequently  scarified  with 
a  sharp  lancet.  This  should  be  passed  through  them 
between  the  teeth,  so  as  to  make  a  complete  section.  It 
is  only  in  connection  with  this  treatment,  that  gargles  will 
prove  at  all  beneficial. 

Another  important  item  in  the  local  treatment  of  the 
disease,  consists  in  cleansing  the  teeth  frequently  and 
thoroughly,  with  a  soft  and  elastic  brush.     This  should 


274         PRETERNATURAL    GROWTH    OF    THE    GUMS. 

be  done,  at  least,  five  times  a  day;  namely,  immediately 
after  getting  up  in  the  morning,  after  each  meal,  and  at 
night  before  going  to  bed.  If  any  relics  of  food,  or  ex- 
traneous matter  of  any  sort,  or  clammy  mucus,  be  per- 
mitted to  collect  between  or  around  the  teeth  or  along 
the  margins  of  the  gums,  the  cure  will  be  retarded,  if  not 
wholly  defeated.] 


CHAPTER    THIRTEENTH. 

OF    GUM-BOIL    AND    ABSCESS    [ALVEOLAR    ABSCESS.] 

[Inasmuch  as  the  seat  of  the  above  named  disease  is 
always  within  the  alveolus,  the  gum  being  only  secon- 
darily affected,  it  would  be  more  proper  to  term  it,  as 
Mr.  Thomas  Bell  justly  remarks,  alveolar  abscess,  and 
should  be  treated  of  under  the  head  of  diseases  of  the 
alveolar  process.] 

Carious  teeth  frequently  become  inflamed  at  the  root, 
and  suppuration  takes  place  in  the  socket,  attended  with 
swelling  and  soreness  of  the  gums.  In  these  cases,  the 
same  laws  are  observed  for  the  exit  of  matter  as  in 
abscess  in  general,  viz.  ulceration  takes  place  in  some 
part  of  its  surface,  so  as  to  make  an  outlet  for  the  matter 
in  the  best  possible  situation.  When  matter  forms  at  the 
root  of  a  tooth,  the  periosteum  which  covers  its  fang 
thickens,  and  in  some  cases  becomes  detached  from  it; 
the  matter  is  accumulated  as  in  a  bag,  by  the  extension 
of  which,  considerable  pressure  is  made  against  the  sides 
of  the  socket,  the  consequence  of  which  is,  that  that  part 
of  the  alveolar  process,  situated  on  the  outside,  becomes 
absorbed,  [wasted]   rather  than  that  within  the  mouth.* 

The  ulcerative  process  continues  until  the  gum  bursts, 
nearly  opposite  to  the  place  where  the  point  of  the  fang 
is  situated,  and  thus  the  matter  escapes  from  this  natural 

'Plate  XVI.  Fig.  10,11. 


276  ALVEOLAR    ABSCESS. 

opening :  the  edges  of  the  opening  are  generally  raised, 
having  the  appearance  of  a  small,  red  fungus;  sometimes, 
after  the  discharge  of  the  matter,  the  inflammation  will 
subside;  but  the  gum-boil  rarely  disappears,  and  a  small 
fistulous  opening  remains,  at  which,  matter  continues  to 
be  discharged;  or,  upon  taking  cold,  persons  are  liable  to 
a  recurrence  of  inflammation,  occasioning  a  reaccumula- 
tion  of  matter;  but  which  is  seldom  attended  with  much 
pain.  These  gum-boils,  being  occasioned  by  diseased 
teeth,  are  seldom  cured  without  their  removal;  but,  as 
the  operation  of  extraction  cannot  always  be  submitted 
to,  means  must  be  employed  to  render  them  as  little 
injurious  as  possible. 

[The  matter  does  not  always  make  for  itself  a  passage 
through  the  alveolus  and  gum;  it  sometimes  escapes  into 
the  maxillary  sinus,  but  this  rarely  happens  except  the 
abscess  has  formed  in  the  socket  of  a  superior  molaris, 
which  is  situated  immediately  beneath  this  cavity,  where 
its  floor  is  often  very  thin  and  sometimes  even  penetrated 
by  one  or  more  of  the  roots  of  the  subjacent  teeth. 
Diseases  of  the  antrum  of  a  very  serious  nature  have  been 
produced  in  this  way.  But  the  extraction  of  the  affected 
tooth  in  this,  as  in  the  other  case,  is  generally  soon  fol- 
lowed by  a  subsidence  of  every  unpleasant  symptom.] 

At  the  first  appearance  of  a  gum-boil,  that  is,  as  soon 
as  the  gums,  by  their  swollen  condition  and  soft  feeling, 
together  with  the  sensation  of  throbbing  pain,  indicate 
that  matter  is  already  formed,  a  puncture  should  be  made 
with  a  lancet,  in  order  to  suffer  it  to  escape:  this  will 
relieve  the  pain,  and  prevent  any  extensive  effusion. 

Sometimes  the  tooth  becomes  very  sore,  and  rather 
loose,  in  which  case,  as  it  will  never  be  serviceable,  it 
would  be  far  better  to  extract  it,  which  will  prove  a  cure 
to  the  gum-boil. 


ALVEOLAR    ABSCESS.  277 

When  the  inflammation  occasioned  by  a  carious  tooth 
is  very  great,  we  should  be  particularly  careful  to  guard 
against  its  effects.  The  formation  of  matter  is  often  so 
considerable,  as  to  produce  an  abscess  of  no  small  extent. 
In  some  cases  the  matter  is  contained  within  a  cavity, 
extending  through  the  length  of  one  side  of  the  jaw. 
The  teeth  which  produce  the  most  distressing  symptoms 
are  the  dentes  sapiential  of  the  under  jaw;  when  inflam- 
mation extends  from  either  of  those  teeth  to  the  contig- 
uous parts,  the  swelling  is  speedily  diffused  over  all  the 
cheek,  so  as  to  close  the  eye,  and  cause  a  considerable 
hardness  at  the  upper  part  of  the  neck,  near  to  the  angle 
of  the  jaw. 

The  muscles  of  the  jaw  are  also  affected  by  the  adhe- 
sive inflammation,  and  they  become  so  rigid  that  it  is 
with  great  difficulty  the  mouth  can  be  opened. 

These  cases  require  the  utmost  attention,  for  a  large 
abscess  is  usually  formed,  which,  if  left  to  itself,  generally 
points  externally;  the  ulceration  extends  through  the 
substance  of  the  cheek,  there  producing  a  most  trouble- 
some sore,  which,  when  healed,  leaves  a  deforming  scar. 
To  prevent  these  sad  consequences,  when  the  matter  is 
formed,  a  free  opening  should  be  made,  on  the  inside  of 
the  cheek,  into  the  softest  part  of  the  tumour.  [The 
immediate  extraction  of  the  tooth  however,  would  be 
preferable,  as  the  matter  in  this  case,  if  already  formed, 
would  escape  through  the  alveolus  into  the  mouth.] 

A  common  notion  exists,  that  it  is  extremely  dangerous 
to  extract  a  tooth  at  the  time  the  gum  is  inflamed;  but 
this  is  erroneous.  Certainly,  at  this  time,  the  opera- 
tion is  attended  with  rather  more  pain  than  at  another; 
but,  as  the  carious  tooth  is  the  cause  of  all  disease,  the 
removal  of  it  is  the  most  certain,  and  always  the  most 
speedy,  mode  of  cure. 
*  36 


278  ALVEOLAR    ABSCESS. 

In  those  cases  where  the  mouth  is  closed ,  as  this  prac- 
tice cannot  be  adopted;  we  must  wait  until  the  inflamma- 
tion be  sufficiently  subsided  for  the  mouth  to  be  opened. 

When  inflammation  and  swelling  of  the  gums  and  face 
arise  from  a  carious  tooth,  they  seldom  subside  without 
going  into  the  suppurative  stage.  I  have  frequently 
attempted  by  leeches,  cold  applications,  &c.  to  prevent 
suppuration,  but  have  rarely  succeeded :  the  progress  of 
inflammation  having  been  by  these  means  only  retarded, 
not  prevented ;  for,  after  a  certain  time,  it  has  come  on 
with  redoubled  violence,  and  has  gone  through  its  pro- 
gress :  on  this  account,  whenever  there  is  any  considerable 
swelling,  and  the  patient  too  timid  to  submit  to  the 
extraction  of  the  tooth,  or  if  the  mouth  be  so  much  con- 
tracted that  the  instrument  cannot  be  conveyed  into  it,  I 
think  it  advisable  to  hasten  the  suppurative  process  by 
fomentations,  &c.  and  as  soon  as  a  soft  place  can  be  felt 
on  the  inside  of  the  cheek,  to  introduce  a  lancet,  and  dis- 
charge the  matter.  People  very  often  continue  poulticing 
a  swelling  of  this  kind,  in  order,  as  they  term  it,  to  bring  it 
to  a  head;  in  so  doing,  they  cause  ulceration  to  take 
place  through  the  substance  of  the  cheek.  If  the  tooth 
producing  the  abscess  be  situated  in  the  upper  jaw,  it 
will  discharge  in  the  middle  of  the  cheek;  if  in  the  lower 
jaw,  the  opening  will  be  at  the  lower  part  of  the  jaw, 
either  near  the  angle  or  at  the  edge  of  its  base. 

These  abscesses  are  rarely  healed;  the  painful  symp- 
toms may  subside,  but  the  opening  remains  fistulous, 
attended  with  a  consequent  discharge  of  matter. 

I  have  known  persons  persist  in  their  attempts  to  heal 
these  kinds  of  abscesses  for  some  months.  One  lady 
continued  the  application  of  dressings  and  lotions  to  a  sore 
of  this  kind  for  two  years,  but  with  no  benefit. 

In  all  these  cases,  the  fangs  of  the  teeth  become  very 


ALVEOLAR    ABSCESS.  279 

much  diseased,  and  are  the  cause  of  the  perpetual  dis- 
charge; therefore,  no  cure  of  these  abscesses  can  be 
expected  without  the  extraction  of  the  tooth. 

In  these  cases,  at  the  opening  where  the  matter  was 
discharged,  the  skin  rises  and  acquires  a  sort  of  fungous 
appearance,  being  very  red,  and  of  a  loose,  spongy  tex- 
ture; when  the  tooth  has  been  extracted,  the  discharge 
gradually  diminishes,  and  the  external  opening  closes; 
but,  as  the  inner  part  of  the  integuments  have  been 
destroyed  by  the  ulcerative  process,  in  healing  the  skin 
becomes  contracted,  and  a  deep  scar  or  pit  remains. 

From  the  situation  and  appearance  of  these  scars,  they 
are  liable  to  be  attributed,  by  superficial  observers,  to  the 
effects  of  scrofula,  which,  to  a  female,  or  a  person  of  nice 
feelings,  is  always  a  source  of  uneasiness. 

[When  the  matter  from  the  abscess  has  been  permitted 
to  escape,  for  a  considerable  length  of  time,  from  a  fistu- 
lous opening  through  the  cheek,  or  lower  part  of  the  face 
beneath  the  inferior  maxillary,  the  removal  of  the  tooth, 
though  it  cures  the  abscess,  is  not  always  followed  by  the 
closure  of  the  opening  exteriorly.  A  diseased  action 
having  been  set  up  here  is  often  continued  after  the  cure 
of  the  primary  affection.  Although  this  rarely  happens, 
examples  are  on  record.  Mr.  Thos.  Bell,  in  his  treatise 
on  the  Anatomy,  Physiology,  and  Diseases  of  the  Teeth, 
gives  a  very  interesting  case.  The  plan  of  treatment 
which  he  instituted,  and  which  might  in  like  cases  be 
adopted,  was,  after  the  extraction  of  the  tooth,  the  remo- 
val of  a  circular  portion  of  the  parietes  of  the  tube  to- 
wards the  gum,  and  the  bringing  of  the  integuments 
together  as  a  simple  wound.] 

When  teeth,  which  have  caused  abscesses  of  this  kind, 
are  extracted,  the  fangs  are  found  covered  with  a  fleshy 
substance,  which  are  granulations  extending  to  the  bottom 


280  ALVEOLAR    ABSCESS. 

of  the  socket;  this  being  only  an  effort  of  nature  to  effect 
the  healing  process,  and  to  fill  up  the  cavity  occasioned 
by  that  absorption  of  substance,  which  always  attends  the 
formation  of  matter. 

When  unfortunately  the  patient  is  so  much  under  the 
influence  of  fear,  that  neither  acute  pain  nor  protracted 
suffering  is  sufficient  to  induce  submission  to  the  extrac- 
tion of  the  tooth,  the  inflammation  of  the  jaw  bone  is  often 
so  great  as  to  terminate  in  the  mortification  of  a  large 
portion  of  its  substance. 

The  process  of  exfoliation  is  necessarily  a  tedious  one> 
the  patient  is  in  a  continual  state  of  uneasiness,  and  the 
mouth  is  constantly  filled  with  an  offensive  discharge. 
As  the  process  of  separating  the  dead  portion  of  the  jaw 
from  the  living  advances,  the  gums  gradually  recede  from 
the  alveolar  processes;  at  length  the  dead  bone  begins  to 
separate,  it  gradually  becomes  loose,  and,  when  it  is  com- 
pletely separated  from  the  bony  attachment,  it  may  be 
taken  away. 

In  Plate  XVI.  are  two  specimens  of  the  mortification 
of  portions  of  the  jaw  bone,  in  consequence  of  carious 
teeth. 

Fig.  8  represents  a  portion  of  the  superior  maxillary 
bone,  containing  a  central  and  lateral  incisor,  and  the 
cuspidatus  of  the  left  side :  this  case  occurred  to  a  gentle- 
man whose  lateral  incisor  was  decayed,  he  had  pain  for 
a  day  or  two,  when  his  gums  and  lip  became  swollen ;  in 
this  state,  instead  of  taking  proper  advice,  he  poulticed 
and  fomented  his  face  for  several  days  in  succession :  a 
considerable  quantity  of  matter  formed,  and  discharged 
itself  under  the  lip:  in  this  state  it  continued  for  some 
time;  when  he  applied  to  me,  I  found  that  not  only  the 
diseased  tooth  was  loose,  but  also  the  one  on  each  side. 
I  extracted  the  carious  tooth,  but  found  the  socket  quite 


ALVEOLARABSCESS.  281 

rough,  arising  from  the  destruction  of  the  periosteum.  I 
told  him  I  expected  that  the  socket  of  this  tooth  would 
exfoliate;  a  short  time  afterwards  I  saw  him  again,  when 
on  touching  the  other  teeth,  I  perceived  a  motion  under 
the  gums,  through  the  extent  of  the  three  teeth. 

Some  weeks  after,  the  whole  became  so  loose,  that  a 
slight  force  brought  it  away.  The  parts  then  healed,  but 
not  without  leaving  an  immense  cavity. 

Fig.  9  exhibits  a  similar  case,  which  occurred  to  a 
young  lady,  a  patient  of  Mr.  Williams,  in  the  Borough  of 
Southwark. 

This  lady  was  tormented  by  the  tooth-ache  for  a  long 
period,  her  face  swelled,  and  matter  formed;  but  all  the 
entreaties  of  Mr.  Williams,  and  the  dreadful  consequences 
which  he  taught  her  to  expect,  could  not  raise  in  her 
mind  sufficient  courage  to  permit  the  tooth  to  be  extrac- 
ted. The  consequence  was,  that  a  large  piece  of  the  jaw 
mortified,  the  bicuspides,  in  consequence  of  their  attach- 
ment to  the  bone  being  destroyed  by  the  ulcerative  pro- 
cess, became  loose,  and,  being  single-fanged  teeth,  were 
easily  taken  away;  at  length  the  piece  of  bone  was  so 
completely  detached,  as  to  allow  of  its  removal,  bringing 
away  with  it  the  diseased  tooth:  at  this  time,  the  second 
molaris,  having  lost  almost  the  whole  of  its  support,  was 
found  to  be  so  loose  as  to  render  it  necessary  to  be  ex- 
tracted. Here  is  an  instance  where  a  person  lost  four 
teeth,  and  a  large  portion  of  the  jaw,  through  an  obstinate 
determination  of  not  submitting  to  the  extraction  of  the 
originally-diseased  tooth. 

I  saw  also  a  woman  in  Bartholomew's  Hospital,  who, 
from  a  similar  cause,  lost  all  the  teeth  with  the  alveolar 
processes  of  the  anterior  part  of  the  lower  jaw. 

When  abscesses  form  in  the  mouths  of  children,  from 
diseases  of  the  temporary  teeth,  the  greatest  care  should 


282  ALVEOLAR    ABSCESS. 

be  taken,  as,  by  an  exfoliation  of  part  of  the  jaw  bone, 
the  teeth  may  be  destroyed.* 

A  knowledge  of  the  evils  which  may  result  from  a 
carious  tooth,  ought  to  influence  all  persons,  who  may  be 
affected  with  this  malady,  to  take  such  early  steps  for 
their  prevention  as  prudence  shall  dictate. 

Sometimes  an  indolent  kind  of  inflammation  will  exist 
at  the  bottom  of  the  socket  of  a  carious  tooth,  occasioning 
a  hard  lump,  or  small  tumour,  of  the  size  of  half  a  nutmeg. 
In  this  state  it  will  continue  for  months,  with  no  other 
alteration  than  being  rather  sore,  when,  in  consequence 
of  a  cold,  a  little  active  inflammation  may  arise. 

These  hard  swellings  should  always  be  regarded  as 
very  dangerous,  because,  as  during  their  indolent  exis- 
tence they  have  caused  a  certain  degree  of  absorption  of 
the  inner  part  of  the  integuments  of  the  face,  if  any  active 
inflammation  occur,  it  very  speedily  runs  on  to  suppura- 
tion ;  and,  as  the  skin  has  already  become  thin,  ulceration 
to  the  external  part  takes  place  so  rapidly,  that  I  have 
known  an  opening  formed  through  the  cheek  in  a  very 
few  days.  On  these  accounts  I  always  endeavour  to 
persuade  patients  to  have  any  tooth  extracted,  which  may 
be  accompanied  with  any  hardness  or  swelling.  It  is  also 
much  better  to  submit  to  the  extraction  of  any  carious 
tooth  which  has  produced  an  abscess;  for  it  will  be 
always  a  source  of  trouble,  as  well  as  occasion  an  offen- 
sive state  of  the  breath. 

[A  very  singular  case  of  alveolar  abscess  fell  under  the 
observation  of  the  editor  about  four  years  ago.  The 
subject  of  which  was  a  lady  about  thirty  years  of  age. 
She  had  been  troubled  with  a  dripping  of  pus  from 
behind  the  curtain  of  her  palate  for  near  twelve  months, 
and  becoming  somewhat  alarmed  at  its  long  continuance, 

*  Vide  Natural  History  of  the  Teeth,  page  105. 


ALVEOLAR    ABSCESS.  283 

called  the  attention  of  her  family  physician,  Professor 
Bond;  to  it,  who  after  having  carefully  examined  the  case, 
endeavoured  to  trace  it  to  its  origin.  He  soon  came  to 
the  conclusion  that  it  come  from  the  socket  of  a  diseased 
tooth,  and  after  passing  his  finger  around  on  the  gums 
covering  the  alveolar  border,  discovered  a  protuberence 
over  the  extremity  of  the  root  of  each  superior  central 
incisor,  nearly  the  size  of  a  hazelnut.  This  tended  to 
confirm  the  opinion  which  he  had  formed  with  regard  to 
the  place  whence  the  matter  came,  and  he  requested 
us  to  visit  the  lady  with  him,  which  we  did,  and  on 
examining  the  case  advised  the  immediate  removal  of  the 
affected  teeth,  and  the  more  strongly,  as  they  were 
found  to  be  in  a  necrosed  condition. 

The  lady  readily  consented  to  the  operation,  which 
was  performed  on  the  following  day.  The  discharge 
behind  the  curtain  of  the  palate  immediately  ceased,  and 
thus  the  patient  was  relieved  from  an  affection  that  had 
proved  a  source  of  great  annoyance  to  her.  The  pus 
from  the  abscess  in  this  case,  instead  of  passing  out 
through  the  alveolus  and  gum,  had  effected  a  passage 
through  the  nasal  plates  of  the  superior  maxilla,  passed 
back  over  the  roof  of  the  mouth  and  escaped  in  the 
manner  as  described. 

The  following  highly  interesting  case  of  alveolar  ab- 
scess, described  by  Dr.  I.  I.  Greenwood  of  New  York, 
is  quoted  from  the  American  Journal  of  Dental  Science.* 

"Some  few  years  past  a  foreign  gentleman  applied  to 
me  for  professional  aid,  who  had  been  treated  by  an 
eminent  surgeon  dentist  for  several  years  for  a  diseased 
dens  sapientiae.  On  examining  the  case,  the  malady  was 
found  to  be  seated  in  the  alveolus  of  the  tooth  on  the 
right  labial  side  of  the  dracranian  maxillary  at  the  base  of 

*  Vide  Vol.  II.  page  291. 


284  ALVEOLAR    ABSCESS. 

the  coronoid  process,  where  it  forms  a  conjunction  and 
continuation  of  the  alveoli.  In  the  first  instance  it  had 
been  formed  by  an  erosive  exposure  of  the  medulla  of 
that  organ.  The  patient  being  of  a  timid  disposition,  and 
the  surgeon  not  determined  in  extracting  the  tooth,  an 
abscess  had  formed,  and  the  pus  passing  off  from  the 
weight  of  the  matter  aslantwise,  and  through  the  base  of 
the  alveolus  of  the  tooth,  had  perforated  the  Levator,  af- 
fecting the  rotary  muscles  opposite  the  orifice,  and  through 
the  anterior  surface  of  the  skin,  immediately  under  the 
centre  of  the  belly  of  the  digastricus,  where  it  pierces  the 
meatus  auditoriusexternus,  forming  a  considerable  orifice; 
which  issue  he  was  in  the  habit  of  probing  with  a  silver 
instrument,  about  six  inches  in  length,  and  cleansing  with 
lint,  &lc.  It  was  found  that  in  making  use  of  this  instru- 
ment and  forcing  it  in  the  whole  length  of  the  canal, 
which  was  straight  and  considerably  indurated,  the  rigidity 
being  such  that  the  digastricus  could  not  have  its  full 
force  of  expansion,  and  the  masseter  muscle  of  that  side 
at  its  lower  portion  was  affected  as  well  as  the  pterygoi- 
deus  externus  in  such  a  manner,  that  the  patient  was  not 
enabled  to  open  his  mouth  more  than  half  an  inch. 

By  further  probing  the  wound  the  instrument  was 
found  to  strike  upon  a  hard  substance  at  the  base,  which 
by  the  sound  was  known  to  be  the  fangs  of  the  diseased 
organ.  The  alveolus  being  destroyed  on  that  side  of  the 
diacranian  opposite,  and  on  the  labial  section  of  the 
surface  of  the  tooth;  from  the  continuous  issue  of  matter, 
the  tooth  irritating  and  acting  as  an  extraneous  body,  and 
causing  this  flow,  it  was  determined  at  once  to  perform 
the  operation  of  extraction.  No  worse  result  could  take 
place  when  the  member  was  removed.  The  cutting  was 
carefully  yet  fearlessly  made,  and  the  operation  performed. 
The  patient  immediately  feeling  relief,  the  sanguineous 


ALVEOLAR    ABSCESS.  285 

discharge  which  followed  was  somewhat  free,  and  con- 
sidered as  favourable.  Yet  still  the  indurated  canal  re- 
mained, and  the  rigidity  of  the  parts  not  remedied.  The 
patient  was  advised  when  the  wound  healed  in  a  measure, 
to  lubricate  the  parts  externally  with  emollients,  such  as 
had  been  prescribed  by  his  physician  and  were  of  a 
mercurial  nature,  to  cause  a  pliantness  and  relaxation  of 
the  muscles.  The  advice  was  concurred  in,  and  a  resti- 
tution of  the  parts  was  the  effect  of  the  application."] 


37 


CHAPTER    FOURTEENTH. 

DISEASES    OF    THE    ALVEOLAR    PROCESSES. 

The  alveolar  processes  are  elongations  of  the  external 
and  internal  tables  of  the  maxillary  bones,  which,  being 
united  by  transverse  processes,  are  divided  into  cavities 
called  alveoli,  or  sockets,  for  containing  the  fangs  of  the 
teeth. 

The  alveolar  processes  are  to  be  considered  as  neces- 
sarily belonging  to  the  teeth,  and  not  essential  to  the 
formation  of  the  jaw  bones.  In  the  earlier  part  of  life, 
they  contain  the  rudiments  of  the  teeth,  which  they 
accompany  in  their  growth,  and  when  the  teeth  are 
completely  formed,  they  acquire  a  form  exactly  suitable 
to  the  shape  of  the  fangs. 

The  alveolar  cavities  are  lined  with  a  vascular  mem- 
brane, analogous  to  the  periosteum  in  other  bones;  this 
membrane  is  also  attached  to  the  fangs  of  the  teeth,  and 
by  it  the  teeth  are  fixed  in  their  sockets:  the  alveoli 
are  larger  than  the  fangs  of  the  teeth  they  are  meant  to 
contain,  as  may  be  seen  by  examining  a  skull  that  has 
been  macerated;  where  the  membranous  parts  being 
destroyed,  those  teeth  which  have  single  fangs  drop  out, 
whilst  the  others  are  retained  by  the  irregular  shape  of 
their  fangs.  On  this  account  it  is,  that  the  teeth  have  a 
certain  degree  of  motion,  which  is  of  great  benefit  in 
mastication,  thereby  preventing  that  injury  which  might 


DISEASES    OF    THE    ALVEOLAR    PROCESSES.       287 

arise  from  the  concussion  consequent  on  the  breaking  of 
hard  substances.  This  motion  of  the  teeth  in  their 
sockets,  is  made  evident  to  all  persons  when  the  fangs  of 
a  tooth  are  inflamed ;  hence,  many  expect  that  the  opera- 
tion of  extraction  will  be  attended  with  little  pain,  and  no 
difficulty;  an  error  which  we  cannot  be  too  careful  to 
correct,  by  explaining  that  the  looseness  of  the  tooth  is 
only  its  natural  motion,  now  become  more  observable 
from  the  increased  sensibility  of  the  periosteum.  This 
explanation  leads  the  patient  to  abandon  those  delusive 
expectations,  and  preserves  the  surgeon  from  the  imputa- 
tions, of  having  given  unnecessary  pain.  [Not  only  is 
the  motion  of  a  tooth  more  perceptible  when  its  alveolar 
membranes  are  inflamed,  but  it  is  actually  looser,  and  this 
results  from  its  being  slightly  raised  from  its  socket  by 
the  swollen  and  thickened  condition  of  the  periosteal  tissue 
which  surrounds  its  root,  or  roots,  if  it  have  more  than 
one.] 

The  alveolar  processes  are  always  sympathetically 
affected  by  all  the  diseases  of  the  teeth  and  gums.  When 
inflammation  affects  either  the  teeth  or  gums,  it  shortly 
extends  to  the  alveolar  processes;  in  consequence  of 
which,  an  increased  action  of  the  absorbents  is  induced, 
and  the  substance  is  removed.  An  absorption  of  the 
alveolar  processes  invariably  follows  a  loss  of  the  teeth, 
occasioned  by  any  cause  whatsoever.  This  may  be 
noticed  in  very  old  persons,  who  have  lost  all  their  teeth; 
the  upper  jaw  becomes  much  diminished  in  extent,  and 
the  roof  of  the  mouth,  instead  of  being  arched,  is  ren- 
dered nearly  flat;  the  under  jaw  becomes  simply  a  thin 
bone  covered  by  the  gums.  Thus,  by  the  removal  of 
the  teeth  and  alveolar  processes,  a  loss  of  substance  is 
sustained  nearly  equal  to  an  inch  and  a  half  in  depth ; 
and,  when  this  is  the  case,  the  muscles  of  the  lower  jaw, 


288        DISEASES    OF    THE    ALVEOLAR    PROCESSES. 

in  the  endeavour  to  draw  it  against  the  upper,  produce 
those  characteristic  marks  of  old  age,  the  shortened  face, 
the  wrinkled  cheek,  and  the  projecting  chin. 

The  alveolar  processes  have  certain  diseases  peculiar 
to  themselves,  independent  of  affections  arising  from  the 
teeth  and  gums.     The  most  common  disease  to  which 
they  are  subject,  is  a  gradual  absorption  of  their  sub- 
stance,  whereby  the   teeth  lose  their   support,  become 
weak,  and  at  length  are  so  loosened  as  to  drop  out.    This 
disease  usually  begins  to  show  itself  in  persons  between 
forty  and  fifty  years  of  age;  and,  from  its  frequent  occur- 
rence without  any  evident  cause,  it  would  seem  to  be  a 
consequence  of  having  passed  the  middle  period  of  life. 
In  the  majority  of  cases  in  which  this  disease  occurs, 
the  teeth  are  perfectly  sound,  and,  from  numerous  obser- 
vations, I  think  I  may  venture  to  assert,  that  persons  who 
have  had  several  of  their  teeth  affected  with  caries  in  the 
early  part  of  life,  are  not  liable  to  lose,  by  an  absorption 
of  the  sockets,  those  which  remain  sound ;  but  where  the 
teeth  have  not  been  affected  with  caries  in  the  early  part 
of  life,  persons,  as  they  approach  fifty  years  of  age,  and 
often  much  earlier,  have  their  teeth  become  loose  from 
absorption,  or  a  wasting  of  the  alveolar  processes. 

When  the  alveolar  processes  are  removed  by  the  action 
of  the  absorbents,  the  gums  which  are  supported  by  the 
alveolar  processes,  partake  also  of  the  disease;  thus,  in 
the  progress  of  the  disease,  as  the  absorption  of  the  bony 
matter  advances,  the  gums  lose  their  attachment  to  the 
teeth,  and  recede  in  proportion  to  the  wasting  of  the  sock- 
ets. Hence  when  an  absorption  of  the  socket  is  taking 
place,  the  necks  of  the  teeth  become  exposed,  and  the 
teeth  appear  to  increase  in  length;  which  circumstance 
has  caused  many  persons  to  imagine  that  they  are  actual- 
ly extended  by  natural  growth.     In  this  opinion,  how- 


DISEASES    OF    THE    ALVEOLAR    PROCESSES.     289 

ever,  they  are  soon  undeceived;  for,  as  the  disease 
increases,  the  teeth  become  weak,  and  at  length,  by 
losing  their  natural  support,  are  rendered  so  exceedingly 
loose,  that,  in  a  short  time,  they  drop  out. 

Sometimes  this  disease  proceeds  without  the  appear- 
ance of  any  assignable  cause,  the  gums  retain  a  very 
healthy  aspect,  are  quite  free  from  pain  or  inflammation, 
and  yet  will  gradually  recede,  until  the  teeth  become 
very  loose. 

The  causes  which  more  particularly  produce  this  affec- 
tion are  such  as  occasion  any  continued  or  considerable 
inflammation  of  the  gums.  These  are  an  accumulation 
of  the  tartar  about  the  teeth,  an  habitual  predisposition  in 
the  gums  to  inflammation,  as  happens  in  that  disease  com- 
monly called  the  scurvy  in  the  gums,  or  that  state  of  them 
which  is  produced  by  the  action  of  mercury. 

When  this  disease  attacks  the  alveolar  processes  in 
both  jaws,  it  is  generally  discovered  by  all  the  teeth 
appearing  longer,  and  having  larger  spaces  between  them 
than  formerly,  accompanied  also  with  a  difficulty  of  mas- 
ticating hard  substances.  Soon  after  a  person  has  made 
these  remarks,  he  finds  some  one  tooth  become  loose, 
occasioning  much  uneasiness,  by  preventing  the  use  of 
that  side  of  the  mouth  in  which  it  is  situated,  and  there- 
fore its  removal  is  determined  upon.  Shortly  afterwards 
another  tooth  fails,  and  so  in  succession,  until,  in  the 
course  of  eight  or  ten  years,  most  of  the  teeth  are  lost* 

In  some  cases  of  absorption  of  the  alveolar  processes, 
and  removal  of  the  gums,  the  disease  causes  a  very  pecu- 
liar appearance;  the  gums  are  very  much  swelled 
between  the  teeth,  the  fangs  are  uncovered  irregularly, 
and  are  also  quite  black. f 

*Plate  XVIII.  Fig.  5.  fFig-  •• 


290       DISEASES    OF    THE    ALVEOLAR    PROCESSES. 

Sometimes  the  alveolar  processes  are  affected  only  par- 
tially, the  absorption  being  confined  to  the  sockets  of  two 
or  three  teeth  only,  after  the  loss  of  which  there  may  be 
no  appearance  of  the  disease  for  a  great  length  of  time.* 

When  several  teeth  together  have  become  loose,  as  is 
often  the  case  with  the  incisores,  they  may  be  strength- 
ened in  an  artificial  manner,  by  tying  or  fixing  them  with 
a  silk  ligature,  or  a  fine  gold  wire,  to  those  neighbouring 
teeth,  which  may  happen  to  be  firm.  By  this  operation, 
the  loose  teeth  are  supported  and  kept  steady,  not  only 
giving  comfort  to  the  patient,  but  also  arresting  the  pro- 
gress of  the  disease,  by  removing  that  irritation  which  is 
kept  up  in  the  gums  and  sockets  by  the  looseness  of  the 
teeth. 

[The  destruction  of  the  alveoli  is  not  the  result,  as  sup- 
posed by  the  author,  of  the  direct  action  of  the  absorbents, 
but  of  that  of  the  corrosive  matter  secreted  by  the  gums  on 
their  inner  edge  and  the  periosteal  tissue.  The  wasting 
of  the  alveoli  is  always  preceded  and  accompanied  by  a 
diseased  action  in  the  gums,  and  sometimes  by  a  morbid 
diathesis  of  the  alveolo-dental  membranes.  And  disease 
in  these  tissues,  may  result  from  the  presence  of  diseased 
teeth,  tartar  or  other  extraneous  matter,  or  a  vitiated  or 
morbid  condition  of  the  fluids  of  the  mouth. 

If  the  wasting  of  the  alveolar  processes  were  the  result 
of  a  spontaneous  action  of  the  absorbents,  independently 
of  local  irritation,  they  would  all  be  attacked  at  about  the 
same  time,  but  inasmuch  as  they  are  not,  and  as  some  are 
more  liable  to  be  destroyed  than  others,  and  especially 
those,  the  teeth  of  which  are  most  liable  to  accumulations 
of  tartar,  the  inference  that  the  author's  opinion  is  incor- 
rect, seems  irresistible.     Moreover,  the  matter  secreted 

*Plate  XVIII.  Fie.  7,  8. 


DISEASES    OF    THE    ALVEOLAR    PROCESSES.      291 

by  the  inner  edge  of  the  gums,  around  the  necks  of  the 
teeth;  is  known  to  be  possessed  of  corrosive  qualities,  and 
capable  of  breaking  down  the  calcarious  molecules  of  bone, 
and  the  parts  of  the  alveoli  first  destroyed  are  their  edges, 
which  are  in  contact  with  this  matter. 

The  affection  is  not  a  necessary  consequence  of  old  age, 
as  the  author  seems  to  imagine.  Many  persons  retain  all 
their  teeth  firmly  in  their  sockets  to  extreme  old  age,  but 
that  it  should  frequently  occur,  after  the  middle  period  of 
life,  is  not  to  be  wondered,  when  we  take  into  considera- 
tion the  fact,  that  as  the  healthful  energies  of  the  body 
begin  to  decline,  all  its  fluids  begin  gradually  to  deterio- 
rate, those  of  the  mouth  as  well  as  those  of  other  parts  of 
the  organism,  and  hence  the  morbid  action  in  the  gums 
which  about  this  period  oftentimes  manifests  itself,  and  the 
consequent  gradual  wasting  of  the  alveoli,  and  especially 
when  no  means  are  used  to  counteract  it — such  for  exam- 
ple, as  the  observance  of  thorough  and  constant  cleanli- 
ness of  the  dental  apparatus. 

The  lower  teeth  are  by  far  more  liable  to  loosen  and 
drop  out  from  the  destruction  of  their  sockets  than  the 
upper.  As  soon  as  they  begin  to  loosen,  they,  by  their 
increased  motion  in  their  sockets,  become  a  source  of 
irritation  to  the  gums  and  alveolo-dental  periosteum,  and 
hence  it  is,  that  the  loss  of  three  or  four  loosened  teeth, 
often,  for  a  time  at  least,  arrests  the  progress  of  the 
disease. 

The  employment  of  an  artificial  support,  such  as  liga- 
tures or  wires,  for  teeth  which  are  loose,  is  decidedly 
improper,  for  the  reason,  that  though  it  may  steady  the 
teeth  for  a  short  period,  it  prevents  them  from  being  pro- 
perly cleansed,  and  affords  a  lodgment  to  extraneous 
matter,  and  will  thus  ultimately  increase  the  evil.] 

The  treatment  found  to  be  most  successful  in  arresting 


292     DISEASES    OF    THE    ALVEOLAR    PROCESSES. 

the  progress  of  this  disease,  is  the  removal  of  that  which 
may  appear  to  be  the  exciting  cause.  If  this  be  tartar, 
it  should  be  removed;  and,  if  there  be  a  tendency  to  an 
habitual  deposit,  the  person  should  be  careful,  by  frequent 
attention,  to  prevent  its  accumulation.  In  some  cases, 
this  disease  is  accompanied  with  inflammation  extending 
along  the  fangs  of  the  teeth,  giving  the  sensation  of  ten- 
sion, and  occasioning  great  uneasiness;  this  is  relieved  by 
scarifying  the  gums,  a  practice  which  should  always  be 
had  recourse  to,  as  the  loss  of  blood,  by  abating  the 
inflammation,  relieves  the  pain,  and  checks  the  progress 
of  the  disease. 

Sometimes  the  absorption  of  the  alveolar  processes  is 
attended  with  a  considerable  secretion  of  pus,  which 
oozes  out  from  under  the  gums,  at  the  necks  of  the  teeth. 
This  discharge  is  not  only  very  disagreeable,  but  often 
renders  the  patient  very  unhappy.  Persons  thus  affect- 
ed, from  observing,  when  they  squeeze  the  gums  with 
the  finger,  that  matter  passes  out  at  the  necks  of  the 
teeth,  form  an  opinion,  that  it  must  produce  injurious 
effects  upon  the  sockets  of  the  teeth,  as  well  as  render 
the  breath  offensive;  on  these  accounts,  they  frequently 
squeeze  the  edges  of  the  gums,  and  wipe  the  teeth,  in 
order  to  remove  what  they  consider  to  be  so  offensive 
and  injurious.  This  practice,  however,  cannot  be  too 
strongly  reprobated,  as  it  tends  to  promote  the  very  ef- 
fects they  so  much  fear.  By  frequently  squeezing  the 
gums,  a  constant  irritation  is  kept  up  on  the  secreting 
surface,  by  which  the  discharge  is  not  only  rendered 
more  copious,  but  also  more  acrid. 

In  these  cases,  nothing  more  should  be  done  than  to 
use  a  soft  tooth-brush,  night  and  morning,  and  cleanse 
the  mouth  by  rinsing  it  with  some  lotion,  such  as  a  decoc- 
tion of  Peruvian  bark,  the  infusion  of  roses  with  tincture 


DISEASES    OF    THE    ALVEOLAR    PROCESSES.        293 

of  myrrh  or  tincture  of  catechu,  diluted  arquebusade 
water,  &c.  By  attending  to  these  rules,  the  discharge 
will  be  moderated,  and  the  mouth  become  much  more 
comfortable.  [In  addition  to  the  foregoing,  the  ulcerated 
edges  should  be  touched  with  a  solution  of  nitrate  of 
silver.] 

An  extraordinary  change  in  the  position  of  the  teeth  is 
sometimes  produced  by  a  slow  and  peculiar  absorption  of 
the  alveolar  processes.  The  teeth  advance  from  the  pos- 
terior to  the  anterior  part  of  the  mouth,  and  cause  the 
incisores  to  become  irregular;  this  irregularity  sometimes 
increases,  even  to  the  entire  projection  of  one  tooth  :  and, 
if  the  projected  tooth  should  become  loose,  and  be  ex- 
tracted, the  loss  will  not  be  perceived,  as  the  tooth  on 
each  side  has  approached  so  near  to  each  other.  In  this 
manner  I  have  seen  the  cuspidati  advance  so  much  to- 
wards the  symphysis  of  the  jaw  as  not  to  leave  sufficient 
space  for  more  than  two  teeth.  [The  loss  however  of 
two  of  the  front  teeth,  even  though  the  space  between 
the  cuspidati  be  filled,  gives  to  the  teeth  a  disagreeable 
appearance.] 

This  alteration  in  the  position  of  the  teeth  arises  from 
an  absorption  of  the  transverse  alveolar  processes,  and  the 
irregularity  from  the  difference  which  exists  in  the  form 
of  the  fangs  and  the  crowns  of  the  teeth;  the  former 
being  much  thinner  than  the  latter,  necessarily  occasion, 
when  the  fangs  are  approximated,  a  considerable  irregu- 
larity in  the  position  of  the  teeth.  When  this  kind  of 
change  takes  place  in  the  teeth  of  the  upper  jaw,  the  in- 
cisores project  so  much  as  to  be  placed  one  over  the 
other,  and  produce  very  great  deformity.* 

There   is   another   disease  of  the   alveolar   processes 

•Plate  XVIII.  Fig.  4. 

38 


294       DISEASES    OF    THE    ALVEOLAR    PROCESSES. 

frequently  occurring,  but  which  diners  from  the  appear- 
ances already  described.  It  rarely  affects  more  than  one 
tooth  at  the  same  time,  and,  instead  of  being  an  absorption 
of  the  socket,  it  is  a  filling  up  or  contraction  of  the  bottom 
of  it,  by  which  it  becomes  shortened,  and  the  tooth 
consequently  pushed  out. 

The  appearance  produced  is  an  increase  in  the  length 
of  the  tooth :  the  gum  is  not  affected,  but  retains  its 
natural  situation.  As  the  disease  in  the  socket  advances, 
the  tooth  continues  to  be  protruded,  until  it  loses  so  much 
of  its  support  as  to  become  loose,  after  which  it  soon 
drops  out.  The  loss  of  the  tooth  is  much  hastened  by 
occasionally  striking  against  the  teeth  in  the  other  jaw:  a 
disagreeable  effect  is  also  produced  in  the  symmetry  of 
the  mouth,  by  one  tooth  being  much  longer  than  the 
others.  In  this  case,  all  that  can  be  done,  is  to  file  away 
a  portion  of  the  lengthened  tooth,  so  as  to  make  it  even 
with  the  others.  This  operation  should  be  performed 
from  time  to  time,  as  the  tooth  continues  to  be  protruded, 
which  will  save  it  from  being  struck  by  the  other  teeth, 
and  obviate  the  deformity  arising  from  the  otherwise 
unavoidable  irregularity.* 

The  alveolar  processes  occasionally  become  enlarged 
by  exostosis.  This  sometimes  takes  place  at  that  part 
formed  by  the  union  of  the  superior  maxillary  bones; 
the  central  incisores,  from  being  closely  situated  together, 
become  so  much  separated  as  to  appear  as  if  a  tooth  had 
been  extracted.  The  same  circumstance  also  sometimes 
occurs  at  the  symphysis  in  the  lower  jaw.f 

I  once  met  with  a  case  of  considerable  enlargement  of 
the  alveolar  processes  at  the  posterior  part  of  the  upper 
jaw,  in  which  the  molares  were  still  remaining;  great 
deformity  was  occasioned  by  the  projection  of  the  cheek. 

*  Plate  XVIII.  Fig.  1,2.  tFig.  3. 


DISEASES    OF    THE    ALVEOLAR    PROCESSES.       295 

The  practice  adopted  was  to  extract  the  teeth  with  the 
view  of  producing  a  decrease  in  the  size  of  the  tumour 
by  that  absorption  of  the  alveolar  processes  which  always 
follows  the  removal  of  a  tooth.  This  proved  very  suc- 
cessful, for  the  tumour  was  not  only  diminished  in  size, 
but  the  progress  of  the  disease  was  arrested. 


CHAPTER    FIFTEENTH. 

OF    THE    TARTAR    [SALIVARY    CALCULUS]    OF    THE    TEETH. 

Excepting  the  disease  of  caries,  nothing  is  so  de- 
structive of  the  healthy  condition  of  the  mouth,  or  of  the 
duration  of  the  teeth,  as  the  accumulation  of  tartar.  This 
is  an  earthy  substance  held  in  solution  by  the  saliva,  and 
is  deposited  upon  the  teeth,  as  the  saliva  undergoes  de- 
composition. Almost  every  person  is  subject  to  a  forma- 
tion of  it  in  a  greater  or  less  degree ;  in  some,  the  deposit 
is  so  habitual  and  copious,  that  without  unremitted  atten- 
tion, their  teeth  cannot  be  preserved  in  a  decent  state; 
whereas,  in  others,  it  is  so  small  in  quantity  that  the  least 
degree  of  care  is  sufficient  to  keep  the  teeth  perfectly 
clean. 

The  formation  of  tartar  is  much  influenced  by  the  state 
of  the  health;  for,  during  the  continuance  of  any  febrile 
complaint,  in  which  the  secretions  of  the  whole  alimen- 
tary canal  are  disordered,  the  mouth  and  teeth  are  loaded 
with  a  thick  mucus;  hence  there  is  commonly  a  very 
large  accumulation:  the  same  also  is  observed  during 
confinement  from  any  cause  whatever,  when  there  is  not 
an  opportunity  of  constantly  cleansing  the  teeth :  it  is 
remarkably  so  in  the  confinement  attendant  on  partu- 
rition. [Some  temperaments  too  are  more  favourable  to 
depositions  of  this  substance  than  others,  and  the  relative 
proportion   of   the    earthy  and    animal    constituents   of 


SALIVARY    CALCULUS.  297 

tartar  varies  in  different  dispositions,  but  for  a  descrip- 
tion of  its  physical  characteristics  the  reader  is  referred 
to  Part  Second  of  the  editor's  Principles  and  Practice 
of  Dental  Surgery.] 

After  sleep.,  the  teeth  are  usually  found  covered  with  a 
viscid,  yellowish  mucus,  which,  if  not  entirely  removed 
by  the  use  of  a  tooth-brush  and  washing,  adheres  to  the 
teeth  in  those  parts  not  subject  to  friction  during  masti- 
cation. Through  neglect,  this  viscid  mucus  gradually 
accumulates,  depositing  itself  in  layers  until  it  acquires  a 
hard  consistence,  and  sometimes  a  magnitude  equal  to 
that  of  the  teeth  themselves. 

When  the  tartar  is  soft,  it  has  a  yellowish  [or  whitish] 
appearance:  but  as  it  becomes  harder,  it  changes  to  a 
dark  brown,  or  a  black  colour;  in  this  way  the  teeth  are 
rendered  very  disgusting  to  the  eye,  and,  by  its  effects 
on  the  gums,  a  very  disagreeable  fetor  is  communicated 
to  the  breath. 

In  the  formation  of  tartar  about  the  teeth,  it  insinuates 
itself  under  the  gums,  and  detaches  them  from  the  necks 
of  the  teeth;  the  gums  are  thus  brought  into  a  diseased 
state,  are  subject  to  inflammation  and  pain,  and  at  last 
gradually  recede  from  the  teeth.  This  state  of  the  gums 
soon  causes  the  alveolar  processes  to  become  affected,  and 
absorption  in  them  is  induced;  so  that,  in  proportion  to 
the  increase  and  accumulation  of  tartar  about  the  teeth, 
their  natural  support  is  destroyed,  they  become  loose,  and 
at  length,  by  some  accident,  a  large  piece  of  tartar  is 
broken  off,  when  the  tooth,  being  deprived  of  its  artificial 
support,  drops  out.  In  like  manner,  the  other  teeth  give 
way  one  after  the  other,  until  in  a  few  years  the  greater 
number  are  entirely  lost.  Persons  who  lose  teeth  from 
this  cause,  complain  that  they  came  away  perfectly  sound, 
not  considering  it  as  the  effect  of  their  negligence;  and  it 


298  SALIVARY    CALCULUS. 

is  but  too  commonly  the  the  case  that  nothing  less  than 
commencement  of  the  loss  of  teeth  induces  them  to  pay 
attention  either  to  their  cleanliness  or  preservation. 

The  tartar  always  accumulates  in  greater  quantity  about 
those  teeth  situated  near  to  the  openings  of  the  salivary 
ducts;  and;  in  some  few  instances;  it  has  been  found,  in 
no  inconsiderable  quantity,  in  the  ducts  themselves: 
hence,  the  inner  side  of  the  incisores  in  the  under  jaw, 
and  the  external  sides  of  the  molares  in  the  upper  jaw, 
are  the  most  covered  by  it.  If,  on  account  of  a  carious 
tooth  that  may  be  tender,  only  one  side  of  the  mouth  be 
used  in  eating,  the  teeth  on  the  other  side  usually  become 
very  much  incrusted;  which  circumstance  demonstrates 
that  the  friction  of  the  food  in  mastication  very  much 
tends  to  cleanse  the  teeth. 

There  is  another  kind  of  tartar  which  collects  chiefly 
about  the  teeth  of  young  persons :  it  is  of  a  dark  green 
colour,  rather  resembling  a  stain  than  an  earthy  con- 
cretion: it  is  very  injurious  in  its  effects  upon  the  teeth, 
as  it  corrodes  the  enamel,  and  disposes  the  teeth  to  be- 
come carious. 

In  Plate  XIX.  are  a  variety  of  examples  of  accumu- 
lated tartar,  showing  also  the  manner  in  which  it  pro- 
duces its  injurious  effects. 

The  deposition  of  tartar  is  an  unavoidable  circumstance, 
depending  upon  the  effusion  and  decomposition  of  saliva; 
but  it  is  in  the  power  of  most  persons  to  keep  their  teeth 
free  from  an  injurious  accumulation,  by  carefully  washing 
and  brushing  the  teeth  every  morning,  to  remove  that 
soft  matter  which  is  deposited  during  the  night,  and  also 
by  rinsing  the  mouth  after  meals,  to  cleanse  them  from 
those  particles  of  food  that  may  lodge  about  them,  and 
which,  being  left  in  the  intermediate  spaces  of  the  teeth, 
become  changed  during  the  night,  and  not  only  contribute 


SALIVARY    CALCULUS.  299 

much  to  the  formation  of  tartar,  but  also  produce  a  tainted 
breath  [and  caries  of  the  teeth.] 

If  the  constant  use  of  a  tooth-brush  and  water  be  not 
sufficient  to  keep  the  teeth  perfectly  clean,  a  tooth-pow- 
der may  be  used,  composed  of  some  substance  not  pos- 
sessing any  chemical  property  which  can  act  on  the 
enamel,  or  of  too  hard  a  quality,  by  which  it  would  grind 
it  away.  [The  use  of  waxed-floss  silk  as  before  directed 
will  also  be  found  a  valuable  auxiliary  to  the  brush.] 

Powders  for  this  purpose  may  be  composed  of  any  of 
the  finely  powdered  earths,  or  boles,  or  any  of  the 
testaceous  powders;  charcoal,  finely  levigated,  has  been 
recommended  and  much  approved  by  many.  In  the 
formation  of  a  tooth-powder,  no  ingredient  ought  to  be 
used  that  can  have  any  chemical  action  upon  the  enamel 
of  the  teeth;  nothing  more  is  desirable  than  something 
which  will  mechanically  act  with  the  brush,  in  taking 
from  the  teeth  that  inspissated  mucus  which  forms  [or 
rather  mixes  with  and  agglutinates  the  particles  of  the 
tartar  together,]  nor  should  any  acid  be  introduced  into 
washes,  tinctures,  essences,  or  dentifrices,  for  diseases  of 
the  gums,  as,  by  their  power  in  decomposing  the  enamel, 
the  greatest  injury  is  done  to  the  teeth.  In  cases  of 
disease,  where  acid  remedies  are  necessary,  persons 
should  be  careful  to  wash  and  wipe  their  teeth  im- 
mediately after  their  exhibition,  to  prevent  future  injury 
of  the  teeth;  for  whatever  renders  the  enamel  thinner 
necessarily  tends  to  the  destruction  of  the  teeth. 

[The  editor  is  of  the  opinion  that  neither  charcoal  nor 
bark  should  enter  into  the  composition  of  dentifrices,  for 
the  reason  that  it  gets  between  the  edges  of  the  gums  and 
necks  of  the  teeth,  where  it  oftentimes  remains  for  years, 
giving  to  the  margin  of  the  former  a  blackish  or  reddish 
brown  appearance.     It  moreover  is  a  constant  source  of 


300  SALIVARY    CALCULUS. 

irritation.  Equal  parts  of  prepared  chalk;  oris  root  and 
castile  soap,  finely  pulverized  and  passed  through  a  fine 
sieve,  constitute  a  much  better  dentifrice,  but  no  powder 
should  be  employed  when  the  gums  are  in  an  inflamed 
and  spongy  condition.] 

When  tartar  has  collected  about  the  teeth,  it  is  to 
be  taken  off  by  means  of  instruments;  this  operation  is 
called  scaling  of  the  teeth,  which  is  one  of  the  most 
useful  and  necessary  for  their  preservation.  Much  pre- 
judice has  been  excited  against  this  operation  by  the  very 
injurious  practice  of  some  dentists,  who  apply  the  muriatic 
or  vitriolic  acid  for  the  purpose  either  of  softening  the 
tartar,  or  whitening  the  teeth :  the  effect  of  these  agents 
upon  the  teeth,  is  to  remove  the  external  coat  of  enamel 
by  its  solution,  and  to  give  to  the  teeth  a  beautiful  white 
appearance  immediately  after  its  application.  The  natural 
polish  of  the  enamel  being  thus  destroyed,  the  surface  is 
left  rough,  and  the  teeth  soon  afterwards  become  dark 
coloured  from  the  adhesion  of  the  colouring  matter 
contained  in  the  food.  But,  if  this  practice  of  applying 
the  acid  be  not  adopted,  and  the  tartar,  as  it  may  accu- 
mulate, from  time  to  time,  be  carefully  removed  from  all 
parts  of  the  teeth,  the  gums  will  be  preserved  in  a  healthy 
state,  and  absorption  of  the  alveolar  processes  be  entirely 
prevented. 

The  tartar,  when  it  has  been  suffered  to  accumulate  in 
large  quantities,  should  be  taken  off  cautiously,  otherwise 
the  sudden  exposure  of  the  necks  of  the  teeth  will  be  a 
cause  of  tenderness  and  pain.  In  such  cases,  a  small 
portion  of  tartar  should  be  removed  at  a  time,  beginning 
at  the  edges  of  the  gums,  which  will  permit  them  to 
grow  up  about  the  necks  of  the  teeth;  by  this  gradual 
procedure,  a  week  or  fortnight  intervening  between  each 
operation,  a  very  large  quantity  of  tartar  may  be  removed 


SALIVARY    CALCULUS.  301 

without  occasioning  the  slightest  inconvenience:  in  the 
interim,  the  gums  should  be  frequently  washed  with  an 
astringent  lotion. 

[It  would  be  preferable,  if  it  could  be  done,  to  remove 
the  whole  at  one  time,  but  from  the  turgid  condition  of 
the  gums,  this  is  not  always  possible,  hence  it  becomes 
necessary  to  resume  the  operation,  at  intervals  of  two  or 
three  days,  or  a  week,  until  it  is  completed.] 

I  have  seen  many  cases  of  great  soreness  and  extensive 
ulceration  of  parts  of  the  mouth,  arising  from  large  accu- 
mulations of  tartar.  A  lady  from  the  country  applied  to 
me,  complaining  of  a  sore  mouth,  which  had  baffled  all 
the  attempts  made  by  a  very  skilful  surgeon  to  heal  it. 
The  inside  of  her  cheek  was  in  an  ulcerated  state,  and 
under  the  tongue,  at  the  fraenum,  there  was  a  considera- 
ble thickening,  with  a  line  of  ulcerated  surface.  She  had 
been  in  this  state  for  more  than  twelve  months,  and  could 
only  obtain  temporary  relief  from  any  application.  Her 
teeth  were  covered  with  an  immense  quantity  of  tartar, 
such  as  described  in  Figures  14,  15  and  16  of  Plate  XIX. 
The  edges  of  this  substance,  being  very  ragged  and  sharp, 
were  continually  cutting  into  the  soft  parts,  that  pressed 
against  them.  Sometimes  a  small  portion  would  break 
off,  when,  from  the  new  edge  being  very  sharp,  much 
irritation  immediately  ensued.  I  removed  the  tartar  at 
intervals,  in  the  manner  above  described,  the  sore  places 
healed,  and  since  that  period,  by  an  occasional  removal 
of  newly  formed  tartar,  her  mouth  has  continued  per- 
fectly well. 

In  scaling  the  teeth,  care  should  be  taken  to  use  the 
instruments  with  no  greater  force  than  is  necessary  to 
remove  the  tartar,  lest  the  enamel  be  scratched  or  injured ; 
attention  is  also  required  to  distinguish  an  .irregular- 
formed  tooth  from  the  distorted  shape,  which  accumulated 
39 


302  ANALYSIS    OF    THE    TARTAR. 

tartar  frequently  assumes;  and,  in  teeth  that  are  naturally 
yellow,  not  to  mistake  the  body  of  the  tooth  for  the  extra- 
neous matter  upon  it,  a  discrimination  highly  important, 
when  applied  to  those  yellow  teeth,  with  very  rough  sur- 
faces, described  in  the  Natural  History  of  the  Teeth, 
page  57. 

ANALYSIS  OF  THE  TARTAR. 

Dear  Sir, — The  specimens  of  the  Tartar  of  the 
Teeth,  which  I  received  from  you,  I  have  examined 
chemically.  Previous  to  their  analysis,  I  subjected  a  por- 
tion of  them  to  the  following  experiments.     I  am, 

Dear  Sir, 
Jlrtillery  Place,  Finsburyy  truly  yours, 

Dec.  1,  1805.  W.  H.  Pepys. 

To  Mr.  Fox. 

Tartar  of  the  teeth,  of  a  dirty  white  colour,  inclining  to 
brown  stained  in  parts  yellow  and  green;  spongy,  porous 
texture,  yet  considerably  hard;  when  it  is  detached  in 
large  pieces,  exhibits  the  impression  of  the  teeth  on  which 
it  was  deposited.  The  pieces  which  were  examined 
were  dry  and  free  from  smell.     Specific  gravity  1.5714. 

Sulphuric  acid  1.85  is  immediately  blackened,  the  sub- 
stance becomes  spongy  and  soft,  but  no  complete  solution 
takes  place. 

Nitric  acid  1.12  acts  in  nearly  a  similar  manner  on  this 
substance  as  on  the  teeth. *  A  gas  which  has  the  nega- 
tive properties  of  nitrogen,  is  evolved  in  small  bubbles, 
and  a  flocculent  mass,  of  the  form  of  the  piece  immersed, 
is  left. 

*See  Natural  History  of  the  Teeth,  page  123. 


ANALYSIS.  303 

Solution  of  potash,  boiled  for  some  time  upon  it,  had 
but  little  action;  the  tartar  became  whiter,  the  solution 
yellow ;  upon  the  addition  of  nitric  acid  to  the  separated 
solution,  the  colour  nearly  disappeared  without  any  pre- 
cipitate being  formed:  ammonia  reproduced  the  yellow 
colour. 

The  flocculent  substance  left  by  dilute  nitric  acid,  after 
washing  off  the  acid,  being  boiled  with  solution  of  potash, 
was  not  wholly  dissolved;  the  solution  became  yellow. 
Nitric  acid  being  added,  discharged  the  colour,  which 
ammonia  reproduced. 

Water  boiled  for  some  time  upon  tartar  gave  no  pre- 
cipitate or  turbid  appearance  on  the  addition  of  solution 
of  tannin. 

Tartar  exposed  to  a  red  heat,  in  a  silver  crucible, 
smokes,  accompanied  with  a  greasy  smell,  is  blackened  in 
a  similar  manner  to  bone,  and  becomes  more  easily  solu- 
ble in  nitric  acid,  leaving  a  carbonaceous  residuum. 

The  solutions  of  potash  which  have  been  boiled  on  tar- 
tar, being  neutralized  with  nitric  acid,  gave  no  precipitate 
with  solution  of  nitrate  of  barytes. 

ANALYSIS. 

Fifty  grains  of  tartar  of  the  teeth  were  placed  in  400 
grains  of  nitric  1.12;  nitrogen  gas  was  slightly  liberated: 
in  twenty-four  hours  it  was  diluted  with  two  ounces  of 
distilled  water,  and  then  filtered. 

The  solution  wras  then  precipitated  by  ammonia,  and 
filtered;  and,  upon  the  addition  of  carbonate  of  ammonia, 
remained  clear;  the  precipitate  produced,  being  dried  at 
212°,  weighed  40  grains,  and,  when  ignited,  it  weighed 
35,  which  were  again  soluble  in  dilute  nitric  acid,  giving 
a  copious  precipitate  with  solution  of  acetate  of  lead:  this 


301  ANALYSIS. 

precipitate,  washed,  dried,  and  exposed  to  a  flame,  urged 
by  a  blow-pipe,  fused  in  a  globule,  accompanied  with  a 
bright  phosphorescent  appearance,  and  was  therefore 
phosphate  of  lead. 

The  substance  not  soluble  in  nitric  acid,  was  washed 
and  dried  at  212°,  weighed  15  grains,  and  adhered  firmly 
to  the  filter. 

The  15  grains  of  the  last  experiment  were  boiled  in  a 
solution  of  potash  for  a  quarter  of  an  hour;  being  sepa- 
rated, washed  and  dried  at  212°,  weighed  9  grains. 

The  separated  solution  was  of  a  yellow  colour,  the 
addition  of  nitric  acid  produced  no  precipitate,  but  lost 
colour,  which  was  recovered  by  ammonia. 

The  9  grains  of  residuum  after  treatment  of  the  potash, 
were  placed  in  boiling  concentrated  nitric  acid,  by  which 
they  were  completely  dissolved;  and,  by  the  test  of 
tannin,  proved  the  cartilage  to  have  been  gelatinized. 

Tartar  of  the  teeth  consists  of 

Phosphate  of  lime,         ...         35 
Fibrina,  or  cartilage,      ...  9 

Animal  fat,  or  oil,          ...  3 

Loss,  3 

50 
[The  following  is  the  result  of  an  analysis  by  Berzelius. 
One  hundred  parts  contained, 

Phosphate  of  lime  and  magnesia,  79.0 

Salivary  mucus  and  salavine,       .         13.5 
Animal  matter,  .         .         .         7.5 

100. 


ANALYSIS.  305 

In  an  analysis  made  by  Mr.  Dwindle,  a  scientilic  dentist 
of  Cazenovia,  N.  Y.     One  hundred  parts  yielded, 
Phosphate  of  lime,         ...         60 
Carbonate  of  lime,         .         .         .  14 

Animal  matter  and  mucus,      .         .         16 
Water  and  loss,     .         .         .         .         10 

100 
It  is  probale  that  no  two  analyses  could  be  made  to 
give  the  same  result  for  the  reason  as  before  stated,  that 
the  relative  proportions  of  its  constituents  vary  in  different 
individuals.] 


CHAPTER  SIXTEENTH. 

OF  SCALING  [REMOVING  THE  TARTAR  FROM]  THE  TEETH. 

By  the  term  scaling  the  teeth,  nothing  more  is  meant 
than  the  removal  of  the  tartar;  though,  through  preju- 
dice, a  popular  notion  prevails,  that,  by  scaling  the  teeth, 
a  removal  of  the  enamel  is  intended.     The  instruments 
for  performing  this  operation  are  made  of  various  forms, 
so  adapted,  as  to  be  easily  used  on  the  different  parts  of 
the  teeth.     The  most  conveniently  formed  set  of  instru- 
ments consists  of,  one  having  the  shape  of  a  chisel,  a 
straight  and  a  curved  spear-pointed  instrument;  one  like 
a  rugine,  being  three  pointed,  and  adapted  for  scraping ; 
and  another  form  for  scraping,  but  smooth  at  the  back. 
In  some  sets,  there  may  be  one  or  more  instruments  of 
different  shapes;   but  this  depends  more  upon   caprice 
than  real  utility,  as  it  is  not  so  much  the  form  of  an  in- 
strument that  is  of  consequence,  as  the  proper  manner  of 
using  it.     [The  form  of  the  instruments,  however,  should 
be  such  that  they  may  be  readily  applied  to  every  part  of 
the  teeth,  for  it  is  important  that  every  particle  of  tartar 
be  removed  from  them.] 

The  patient  should  be  seated  in  a  chair,  having  a  high 
back,  that  the  head  may  rest  conveniently ;  and,  by  being 
kept  steady  allow  the  operation  to  be  performed  with 
convenience  to  the  surgeon,  and  ease  to  the  patient. 
Endeavours  should  be  made  to  acquire  a  habit  of  taking 


OF    SCALING    THE    TEETH.  307 

off  the  tartar  without  violence,  operating  with  as  light  a 
hand  as  possible. 

The  chisel-formed  and  straight  spear-pointed  instru- 
ments are  designed  for  the  anterior  surface  of  the  under 
incisores;  the  curved  spear-pointed  and  the  scraping 
instrument  with  a  smooth  back,  for  the  outer  side  of  the 
molares  and  other  teeth;  and  the  three-pointed  instru- 
ment, or  other  scraping  instruments,  for  the  posterior  sur- 
faces of  the  teeth.  By  attending  to  these  hints,  with  a 
little  practice,  a  habit  may  soon  be  acquired  of  removing 
the  tartar  without  leaning  heavily  upon  the  mouth,  or 
jarring  the  teeth,  which  are  two  circumstances  of  con- 
siderable importance. 

[In  the  removal  of  the  tartar  from  the  lower  front 
teeth,  when  they  are  loose,  the  thumb  of  the  left  hand 
of  the  operator  should  be  placed  on  them  in  such  a  man- 
ner as  to  prevent  them  from  being  jarred  or  shaken  in 
the  operation.  The  patient  should  be  directed  to  wash 
his  mouth  from  time  to  time,  during  the  operation,  to  free 
it  from  blood  and  the  small  particles  of  tartar  that  lodge 
along  the  edges  of  the  gums. 

For  the  removal  of  the  tartar  on  the  approximal  sur- 
faces of  the  teeth,  a  thin-bladed  instrument  like  that  of  a 
knife  should  be  employed,  and  the  operator  should  be 
careful  not  to  injure  the  periosteum.  When  the  gums 
are  very  much  swollen  and  inflamed,  and  the  accumula- 
tion very  considerable,  several  sittings  will  be  required  to 
complete  the  operation.  After  which  the  patient  should 
be  directed  to  cleanse  his  teeth  several  times  a  day  with 
a  soft  elastic  brush  and  waxed-floss  silk,  to  prevent  a 
re-accumulation.  If  any  small  particles  be  left  upon  the 
teeth,  they  will  constitute  nuclei  for  its  re-accumulation, 
and  thus,  in  a  measure,  counteract  the  means  employed  to 
prevent  it.     It  is  important  therefore,  that  the  operation 


308  OF    SCALING    THE    TEETH. 

be  thorough^  that  not  a  particle  be  left  upon  the  teeth ; 
and  as  the  presence  of  this  substance,  gives  rise  to  disease 
in  the  gums,  it  is  also  important  that  such  other  treatment 
be  instituted;  as  the  nature  of  the  morbid  condition  in  this 
structure  may  seem  to  require.  But,  as  this  has  been 
described  in  a  preceding  chapter,  it  will  not  be  neces- 
sary to  recapitulate  what  has  been  said  upon  the  subject. 
Some  writers  recommend  for  the  removal  of  this  sub- 
stance from  the  teeth,  chemical  agents, — such  for  exam- 
ple, as  diluted  muriatic  and  even  sulphuric  acids,  but  the 
employment  of  either  of  these,  or  any  acid,  for  this  pur- 
pose, is  highly  improper.  Any  chemical  agent  which 
will  decompose  the  tartar  of  the  teeth,  will  act  upon  the 
teeth,  therefore,  mechanical,  is  the  only  means  that 
should  be  employed  for  its  removal.] 


CHAPTER    SEVENTEENTH. 

THE    EFFECTS    OF    MERCURY    UPON   THE    TEETH. 

When  mercury  has  been  introduced  into  the  system, 
certain  circumstances  occur  which  are  usually  regarded 
as  criteria  of  its  specific  and  constitutional  action.  The 
most  evident  of  these  are  an  increased  discharge  from  the 
salivary  glands,  soreness  of  the  mouth,  and  fetor  of  the 
breath.  The  gums  become  tumid  and  spongy,  are  very 
tender,  and  liable  to  bleed;  the  teeth  also  become  loose, 
and  cannot  bear  the  pressure  necessary  for  the  mastication 
of  hard  substances :  this  loosened  state  of  the  teeth  arises 
from  the  thickening  of  the  periosteum  which  covers  the 
fangs,  and  by  which  the  teeth  are  held  in  the  sockets; 
the  soreness  of  the  gums  is  probably  occasioned  by  that 
fulness  of  the  vessels  which  the  peculiar  action  of  the 
mercury  induces.  These  affections  of  the  teeth  and 
gums  generally  subside  soon  after  the  use  of  mercury  is 
discontinued,  the  teeth  again  become  fast,  and  the  gums 
acquire  their  natural  firmness. 

A  common  consequence  of  the  use  of  mercury  is,  an 
increased  action  of  the  absorbent  vessels,  and  there  is  no 
part  on  which  this  action  is  more  evident  than  the  alveolar 
processes.  On  examining  these  parts  in  persons  who 
have  died  during  the  use  of  mercury,  they  will  be  found 
much  less  dense,  and  of  a  more  porous  texture  than  the 
bone  ought  to  be  in  its  sound  or  natural  state.  The  use 
40 


310       EFFECTS    OF    MERCURY    UPON    THE    TEETH. 

of  mercury  is  therefore  no  uncommon  cause  of  premature 
loss  of  the  teeth;  by  inducing  absorption  [wasting]  of  the 
alveolar  processes;  this  injurious  consequence,  arising 
from  the  use  of  this  remedy,  is  now  greatly  obviated  by 
the  improvement  adopted  in  its  exhibition;  namely,  by 
keeping  up  a  longer  but  slighter  action  of  it  upon  the 
system,  rather  than  that  violent  one  which  accompanied 
the  old  practice  of  salivation. 

Where  the  use  of  mercury  is  carried  very  far,  the 
teeth,  even  during  its  exhibition,  often  become  so  loose 
as  to  drop  out:  in  other  constitutions,  still  greater  mischief 
is  experienced;  there  is  a  considerable  inflammation  of 
all  the  parts  of  the  mouth,  attended  with  great  swelling 
and  ulceration.  This  sometimes  extends  even  to  morti- 
fication of  parts  of  the  jaw-bones.  It  would  not  be 
difficult  to  collect  cases  of  extensive  mischief  following  an 
injudicious  use  of  this  valuable  medicine;  several  striking 
examples  of  which  have  been  presented  to  me  by  various 
surgeons  of  my  acquaintance.  In  Plate  XX.  Fig.  2,  is 
the  representation  of  a  large  piece  of  the  anterior  part  of 
the  under  jaw,  containing  the  incisores  and  cuspidati, 
which  exfoliated,  in  consequence  of  a  long-continued 
salivation. 

Fig.  3  represents  nearly  the  whole  of  the  under  jaw, 
which  mortified  and  exfoliated;  this  person  also  lost 
almost  every  tooth  of  the  upper  jaw,  which  became  loose, 
and  dropped  out. 

A  very  similar  case  occurred  to  a  patient  in  Guy's 
Hospital,  who  applied  for  advice  on  account  of  great  dis- 
ease in  his  mouth,  as  the  consequence  of  a  late  salivation. 
He  had  an  exfoliation  nearly  similar  to  the  last  case,  and 
it  was  surprising  to  observe  how  small  a  deformity  at- 
tended the  loss  of  so  great  a  part  of  the  jaw.  During 
the  progress  of  the  exfoliation,  so  large  a  deposit  of  new 


EFFECTS  OF  MERCURY  UPON  THE  TEETH.   311 

bone  took  place,  around  the  dead  portion,  that  it  became, 
as  it  were,  inclosed  in  a  case;  and,  after  it  came  away, 
the  new  bone  was  rounded,  and  the  gums  healed  over 
very  perfectly. 

Last  year  I  saw  a  most  dreadful  instance  of  the  inju- 
rious consequences  of  an  improper  use  of  mercury,  in  a 
lady,  a  patient  of  Mr.  Norris,  who  had  just  arrived  from 
the  East  Indies,  where  she  had  been  salivated  on  account 
of  a  liver  complaint.     She  had  been  advised  to  employ 
so  much  mercury,  that  she  was  literally  poisoned,  her 
mouth  became  completely  ulcerated,  and  the  w7hole  con- 
stitution Was  so  much  affected,  that  she  lay  for  some  time 
in  a  state  of  insensibility.     As  she  recovered,  the  sore- 
ness of  the  mouth  rendered  the  opening  of  it  painful  and 
difficult;  and,  as  the  ulcers  healed,  so  much  adhesion  and 
contraction  took  place  at  the  posterior  part  of  the  mouth, 
that  it  could  scarcely  be  opened  even  to  admit  a  tea- 
spoon; at  length,  the  contraction  increased  to  that  degree 
that  she  completely  lost  the  power  of  opening  it.     On 
this  account,  she  was  under  the  necessity  of  receiving 
nutriment  in  the  form  of  thick  milk,  soups,  &c.  intro- 
duced into  the  mouth  by  a  large  syringe,  the  pipe  of 
which,  being  curved,  was  passed  into  the  mouth  through 
an  opening  formed  by  the  loss  of  one  of  the  molares.     In 
addition  to  these  calamities,  the  great  inflammation  which 
had  been  excited,  caused  the  mortification  of  nearly  the 
whole  of  the  alveolar  processes  of  both  jaws.     On  sepa- 
rating  the  lips,  a  most  dreadful   appearance  presented 
itself,  the  gums  had  retired  from  the  teeth,  leaving  the 
alveolar   processes   uncovered,  and    quite   black.     I  re- 
moved several  teeth  which  had  become  loose,  and  in  two 
or  three  places  exfoliation  was  beginning  to  take  place. 

The  constant  discharge  of  matter  made  a  very  frequent 
syringing  of  the  mouth  with  tincture  of  myrrh  and  water 


312       EFFECTS    OF    MERCURY    UPON    THE    TEETH. 

absolutely  necessary,  and  had  she  not  possessed  a  most 
exemplary  patience  and  composure  of  mind,  she  must 
have  been  completely  miserable. 

Some  time  since  a  man  became  a  patient  in  Guy's 
Hospital,  who  had  been  so  injudiciously  treated  in  a 
course  of  mercury  as  to  cause  a  complete  ulceration  of  the 
gums  and  the  inner  surface  of  the  cheeks  and  lips.  The 
consequence  of  which  was,  that,  as  the  process  of  healing 
advanced,  so  much  adhesion  of  those  parts  took  place, 
that  the  mouth  could  scarcely  be  opened.  The  man 
could  only  be  relieved  from  this  distressing  situation  by 
the  dissection  of  the  lips  and  part  of  the  cheeks  from  the 
gums,  which  was  performed  by  Mr.  Cooper,  the  parts 
were  then  preserved  from  re-uniting  by  the  interposition 
of  lint,  until  they  had  perfectly  healed. 

During  the  use  of  mercury,  when  the  mouth  becomes 
affected,  it  should  be  frequently  washed  with  a  mild 
astringent  lotion:  for  this  purpose  I  have  usually  recom- 
mended the  infusion  of  roses  with  a  small  quantity  of 
alum;  and,  if  the  soreness  of  the  mouth  be  very  consider- 
able, some  tincture  of  myrrh  may  be  added.  During  the 
exhibition  of  mercury,  there  is  usually  a  considerable 
deposition  of  tartar  about  the  teeth;  to  obviate  the  ill 
effects  of  which,  it  should  always  be  removed,  as  soon  as 
the  medicine  is  discontinued;  the  gum  will  then  soon 
recover  their  healthy  state,  and  material  injury  to  the 
teeth  be  prevented.  [If  it  were  requisite  the  editor  could 
give  the  particulars  of  several  very  interesting  cases  of 
the  pernicious  effects  resulting  from  an  imprudent  use  of 
this  medicine,  but  he  does  not  deem  it  necessary  to  extend 
the  limits  of  this  work  by  so  doing.] 

Effects  similar  to  those  arising  from  the  injudicious  use 
of  mercury  sometimes  attend  that  dreadful  disorder,  the 
small-pox.     In  the  excellent  museum  of  Mr.  Heaviside 


EFFECTS    OF    MERCURY    UPON    THE    TEETH.       313 

are  several  specimens  of  exfoliations  which  have  been 
occasioned  by  the  deadly  operation  of  that  loathsome 
pestilence.  The  preparations  which  the  Figures  4  and 
5  of  Plate  XX.  represent,  have  the  following  statement 
affixed  to  them.  "This  very  curious  exfoliation  is  from 
the  under  jaw  of  a  little  boy  about  four  years  old,  from 
matter  formed  between  the  gums  and  the  bone,  after 
the  small-pox.  As  soon  as  it  became  pretty  loose,  the 
whole  was  carefully  removed,  which  shows  itself  to  be 
the  substance  of  the  lower  jaw,  with  some  teeth  in  it.  A 
small  portion  of  the  anterior  part  of  the  upper  jaw  also 
exfoliated  with  two  of  the  incisor  teeth  and  two  secondary 
teeth." 

A  similar  case  has  for  some  time  past  been  under  the 
care  of  Mr.  Dorratt,  of  Bruton  Street.  A  child  had  the 
small-pox  about  Christmas  last:  soon  after  the  fever  had 
abated,  the  mother  found  a  tooth  upon  the  child's  pillow; 
other  teeth  soon  afterwards  became  loose,  and  dropped 
out.  After  this,  great  swelling  of  the  integuments  cover- 
ing the  face  and  chin,  succeeded;  this  inflammation  soon 
proceeded  to  suppuration,  a  great  quantity  of  matter  was 
discharged  from  the  gums,  which  then  began  to  retire 
from  the  jaw  bones. 

A  large  piece  of  bone,  with  several  teeth,  exfoliated 
from  the  upper  jaw,  and  another  piece  from  the  under 
jaw;  and  when  Mr.  Dorratt  gave  me  the  account  of  the 
case,  he  informed  me  that  he  expected  the  exfoliation  of 
another  large  piece.* 

In  page  114  of  Part  First,  I  could  not  refrain  from 
expressing  the  hope  that  this  scourge  of  mankind  would 
soon  be  driven  from  the  world  by  the  mild,  but  powerful, 
influence  of  vaccine  inoculation;  a  triumph  for  humanity, 
which  might  have  been  achieved  in  our  country  as  well 

♦Plate  XX.  Fig.  6,  7. 


314       EFFECTS    OF    MERCURY    UPON    THE    TEETH. 

as  in  some  of  the  stales  and  cities  on  the  continent.  It 
is  a  lamentable  fact,  that,  in  the  country  that  gave  birth 
to  this  glorious  discovery,  there  should  be  found  persons 
capable  of  taking  every  method  to  alarm  the  fears  and 
excite  the  prejudices  of  the  careful,  but  uninformed, 
parent;  and  who  instead  of  uniting  in  the  benevolent 
effort  to  preserve  human  life,  have  exulted  at  every  unfa- 
vourable circumstance;  and  have  taken  advantage  of 
those  accidents  which  have  resulted  from  negligence  or 
want  of  information ;  and  have  unremittingly  attempted 
to  destroy  the  confidence  of  the  public  in  this  most  salu- 
tary gift  of  Providence. 

But  the  attempts  of  these  persons  have  only  tended  to 
confirm  the  success  of  the  practice;  for,  while  by  the 
industrious  but  malignant  attempt  to  render  the  small- 
pox epidemical,  by  extending  its  inoculation,  the  atmos- 
phere of  the  metropolis  has  been  for  some  time  past 
impregnated  with  the  infection,  the  thousands  who  have 
been  satisfactorily  inoculated  with  the  vaccine  have  re- 
mained in  perfect  health,  although  surrounded  by  the 
most  active  and  virulent  contagion.  I  cannot  but  express 
the  hope  that  the  legislature  will  wisely  interfere,  and,  by 
restricting  the  inoculation  of  the  small-pox,  effectually 
prevent  these  gentlemen  from  indulging  themselves  in 
experiments  so  fatal  to  the  public  welfare;  but  which 
they  openly  endeavour  to  turn  to  their  own  private  emol- 
ument. 

This  wonderful  discovery  was  announced  in  the  year 
1798.  From  our  favoured  isle,  it  was  soon  carried  to  the 
other  nations  of  Europe,  and  to  America.  In  Russia,  by 
the  order  of  the  emperor,  it  has  been  diffused  through  his 
vast  empire.  From  Vienna,  it  was  conveyed  through 
Persia  to  our  possessions  in  the  East,  where  it  was 
received    with    enthusiasm,  not   only  by   the    European 


EFFECTS    OF    MERCURY    UPON    THE    TEETH.       315 

settler,  but  by  the  Hindoo,  it  was  regarded  as  an  im- 
mediate gift  from  Heaven.  Through  the  exertions  of 
Mr.  Ring,  whose  zeal  in  this  cause  must  render  him  esti- 
mable to  every  philanthropist,  it  has  been  successfully 
conveyed  to  our  settlements  in  New  Holland,  and  there  is 
reason  to  believe  that  it  has  been  introduced  into  Africa. 

Thus,  like  the  sun,  has  this  discovery  extended  its 
benign  and  life-preserving  influence  around  the  globe. 
What  gratitude  to  the  Almighty  ought  to  possess  the 
mind  of  him,  on  whom  has  been  conferred  the  happiness 
of  communicating  so  great  a  blessing  to  man !  Long  may 
he  live, — and  may  the  name  of  Jenjver  ever  be  revered 
as  one  of  the  great  benefactors  of  the  human  race! 

[Mercury  does  not,  as  many  suppose,  exercise  any 
direct  action  upon  the  teeth.  It  is  only  by  vitiating  the 
fluids  of  the  mouth,  inducing  inflammation  and  sponginess 
of  the  gums  and  the  destruction  of  the  alveolar  process, 
that  the  teeth  are  prejudicially  affected  by  it.  By  vitia- 
ting the  juices  of  the  mouth,  it  increases  their  corrosive 
qualities  and  renders  them  more  hurtful  to  these  organs, 
and  by  its  effects  upon  the  gums  and  sockets  of  the  teeth, 
it  often  causes  them,  as  stated  by  the  author,  to  loosen 
and  drop  out. 

In  the  treatment  of  sponginess  of  the  gums,  originating 
from  a  mercurial  diatheses  of  the  general  system,  whether 
accompanied  with  ulceration  or  not,  it  is  important  that 
the  use  of  this  medicine  be  first  discontinued,  as  no  bene- 
ficial effect  will  be  obtained  during  its  employment.  The 
mouth  should  be  frequently  gargled  with  some  astringent 
lotion,  such,  for  example,  as  a  decoction  of  sage  and 
honey,  with  a  little  suborate  of  soda.  For  correcting  the 
fetor  of  the  breath,  a  wash  of  the  chloruret  of  soda,  well 
diluted,  to  prevent  injury  to  the  teeth,  will  be  found  very 


316       EFFECTS    OF    MERCURY    UPON    THE    TEETH. 

serviceable.  The  bowels  should,  at  the  same  time,  be 
kept  open  with  some  gentle  aperient. 

Scarification  of  the  gums  is  recommended  by  some 
practitioners,  but  no  advantage  will  be  derived  from  it 
during  the  action  of  the  medicine,  and  even  after  it  has 
ceased  to  act,  its  effects  are  much  less  salutary,  than  in 
sponginess  of  the  gums  which  has  been  produced  by 
other  causes.  It  may  however,  sometimes,  after  the  dis- 
ease has  assumed  a  chronic  form,  be  attended  with  bene- 
ficial results. 

Disease  in  the  gums,  produced  by  a  mercurial  action  of 
the  general  system,  however  perfectly  it  may  have  sub- 
sided, increases  their  susceptibility  to  morbid  impressions. 
Hence,  they  are  ever  after  more  liable  to  disease.] 


CHAPTER    EIGHTEENTH. 

OF    THE    DISEASES    OF    THE    ANTRUM    MAX1LLARE. 

The  antrum  maxillare  is  a  large  sinus  or  cavity  in  the 
superior  maxillary  bone.  It  is  situated  over  the  molares, 
and  under  the  orbitar  plates:  it  is  lined  with  a  mem- 
brane, and  has  communication  with  the  cavity  of  the  nose 
by  a  small  aperture  in  that  part  of  the  side  of  the  sinus 
which  is  membranous,  and  which  is  placed  between  the 
superior  and  inferior  turbinated  bones. 

Inflammation  in  the  antrum  is  often  occasioned  by  dis- 
eases of  the  teeth,  but  it  also  occurs  when  the  teeth  are 
quite  sound.  Sometimes,  in  examining  the  prepared 
bones  of  the  head,  one  or  more  fangs  of  the  large  molares 
may  be  found  passing  into  the  cavity.  In  such  a  case, 
inflammation,  excited  by  a  diseased  tooth  would  speedily 
communicate  to  the  membrane  lining  the  cavity,  and 
cause  suppuration.  [It  however  more  frequently  causes 
an  obliteration  of  the  nasal  opening,  and  a  consequent 
engorgement  of  the  cavity.] 

Much  mischief  usually  follows  the  neglect  of  an  abscess 
of  the  antrum.  The  natural  opening  from  the  cavity  is 
usually  rendered  impervious,  hence  the  matter  is  obliged 
to  make  its  exit  by  an  ulceration  through  one  of  its  sides, 
which  most  frequently  is  that  situated  under  the  cheek. 
It  is  common  to  membranes,  under  inflammation,  to 
become  thickened,  and  as  the  opening  into  the  nose  is 
41 


318        DISEASES    OF    THE    ANTRUM    MAXILLARE. 

through  a  membranous  part,  it  is  probable  that  when  in- 
flammation takes  place,  it  is  in  consequence  of  the  thicken- 
ing of  this  membrane  that  the  opening  of  the  antrum  into 
the  nose  becomes  closed. 

During  inflammation  in  the  antrum,  the  patient  at  first 
conceives  the  pain  to  proceed  from  the  tooth-ache;  but, 
if  the  teeth  should  not  be  diseased,  a  more  accurate 
observation  is  made  upon  the  peculiar  sensations  excited. 
The  pain  usually  extends  towards  the  forehead,  in  the 
direction  of  the  frontal  sinus,  and  a  sensation  of  tightness 
and  weight,  with  throbbing,  is  felt  on  the  side  of  the  face. 
In  a  short  time,  the  cheek  becomes  red,  and  appears  as 
if  swollen;  it  feels  very  hard,  and,  on  raising  the  lip,  a 
considerable  fulness  above  the  fangs  of  the  teeth  may  be 
observed. 

If  the  disease  be  not  attended  to  in  this  stage,  as  the 
matter  rarely  passes  out  at  that  side  leading  into  the  nose, 
an  absorption  of  the  bone  above  the  molares  takes  place, 
and  the  matter  discharges  itself  through  the  gum;  but  this 
does  not  cure  the  abscess,*  the  formation  of  matter  still 
continues,  and  the  ulcerative  process  goes  on,  until  so 
great  a  destruction  of  the  bone  is  caused  as  to  render  the 
disease  incurable. 

This  case  requires  the  same  kind  of  treatment  as 
abscesses  in  general,  viz.  an  outlet  to  be  made  for  the 
matter:  the  best  mode  of  effecting  this  is  by  extracting 
one  of  the  molares,  and  making  a  perforation  into  the 
antrum,  through  the  socket  of  one  of  the  fangs.  If  it 
should  happen  that  either  the  first  or  second  molaris  be 
carious,  it  will  be  proper  to  extract  it;  but,  when  the 
teeth  are   perfectly  sound,  the  second  molaris  is   to  be 

[*  Abscess,  according  to  the  true  definition  of  the  term,  rarely  occurs  in  the 
maxillary  sinus.  Therefore,  it  is  improper  to  term  an  altered  condition  of  its  secre- 
tions and  engorgement  by  that  name.] 


DISEASES    OF    THE    ANTRUM    MAXILLARE.       319 

preferred^  as  the  antrum  descends  the  most  at  that  part, 
and  it  is  desirable  to  have  the  opening  in  the  most  de- 
pending situation. 

When  the  matter  has  been  discharged,  the  object  must 
be  to  restore  the  parts  to  their  former  condition ;  with  this 
view,  a  solution  of  tincture  of  myrrh  is  to  be  frequently 
injected,  with  a  syringe,  through  the  opening.  As  the 
inilammation  subsides,  the  natural  opening  usually  be- 
comes pervious,  and  the  injection  will  pass  into  the  nose: 
when  this  opening  is  restored,  the  discharge  gradually 
diminishes,  the  gum  may  then  be  suffered  to  heal  over 
the  artificial  opening,  and  a  cure  is  effected.  As  there  is 
always  a  disposition  in  the  gum  to  close  over  the  part 
from  whence  a  tooth  has  been  extracted,  it  may  be  kept 
open,  where  the  socket  has  been  perforated,  by  introduc- 
ing a  piece  of  bougie,  which  sticking  at  the  upper  part  of 
the  socket,  and  hanging  just  low  enough  to  be  taken  hold 
off,  may  be  withdrawn  at  the  time  of  syringing,  and  then 
be  again  returned. 

[The  diseases  of  this  cavity  being  caused  in  a  large 
majority  of  the  cases,  by  irritation  produced  by  diseased 
teeth,  it  is  seldom  necessary  to  do  any  thing  more  than 
remove  the  affected  teeth  and  provide  an  outlet  for  the 
escape  of  the  matter  by  perforating  the  floor  of  the  sinus 
through  one  of  the  alveoli.] 

If  the  natural  opening  into  the  nose  has  become  per- 
fectly obliterated,  it  will  be  requisite  to  preserve  an  arti- 
ficial one;  this  may  be  accomplished  by  wearing  a  silver 
tube  in  the  perforated  part,  through  which  the  mucus 
will  constantly  pass  into  the  mouth,  and  future  accumu- 
lations be  prevented. 

I  have  met  with  several  cases  of  disease  in  the  antrum, 
occasioned  by  carious  stumps,  in  which  a  considerable 
enlargement,  with  absorption  of  some  of  the  anterior  part 


320       DISEASES    OF    THE    ANTRUM    MAXILLA  RE. 

of  the  bone  had  taken  place.  The  extraction  of  these 
stumps  has  been  followed  by  a  great  discharge  of  a  gla- 
reous  fluid :  from  the  socket  the  discharge  continues  for 
some  time,  but  it  gradually  diminishes  until  the  part  ac- 
quires a  healthy  state. 

The  antrum  is  sometimes  the  seat  of  formidable  dis- 
eases^ but  these  cases  are  not  common.  That  which 
most  frequently  occurs  is  the  formation  of  a  polypus,  or 
fungous  tumour,  within  the  cavity.  The  usual  progress 
of  this  malady  is,  that  the  tumour  having  acquired  a  cer- 
tain size,  an  absorption  of  the  bone  is  induced  by  the 
pressure,  this  absorption  commences  in  the  internal  part 
of  the  cavity,  which  is  gradually  rendered  thin,  until  the 
whole  is  completely  removed.  The  alveolar  processes 
and  even  part  of  the  fangs  of  the  teeth  are  absorbed, 
when  the  remainder  of  the  teeth,  becoming  loose,  irritate 
the  gum,  and  must  be  extracted.*  The  tumour  contin- 
uing to  increase,  the  cheek  becomes  much  enlarged,  and, 
instead  of  bone  or  fungous  substance,  occupies  the  whole 
side  of  the  face;  at  length  ulceration  takes  place  in  some 
part,  which,  as  it  increases,  is  attended  with  so  consid- 
erable a  discharge  of  matter,  that  the  strength  of  the 
patient  is  gradually  diminished,  and  at  length  the  disease 
terminates  fatally. 

The  antrum  is  sometimes  most  dreadfully  affected  with 
cancerous  disease.  Happily  these  cases  are  very  rare; 
the  only  specimens  that  I  have  seen  are  in  the  possession 
of  Mr.  Heaviside  and  Mr.  Taunton.  The  histories  of 
these  cases  are  very  similar,  the  patients  were  both  el- 
derly women;  at  first  they  complained  of  pain  in  the  side 
of  the  face,  extending  up  to  the  forehead  and  the  eye, 
and  back  to  the  ear;  these  symptoms  continued  for  about 
four  months,  when  a  tumour  formed  near  the  ear,  from 

*  Plate  XVII.  Fig.  17. 


DISEASES    OF    THE    ANTRUM    MAXILLARE.       321 

which,  shortly  afterwards,  there  was  a  discharge  of  a  very 
fetid,  dark-coloured  fluid.  Ulceration  then  began  in  the 
cheek,  over  the  maxillary  bone,  by  which,  after  great 
ravages  had  been  committed,  their  strength  was  gradu- 
ally exhausted,  until  death  terminated  their  sufferings. 
These  cases  were  about  fourteen  months  in  their  pro- 
gress. 

In  the  patient  under  Mr.  Taunton's  care,  the  disease, 
which  was  on  the  right  side,  occasioned  the  absorption  of 
the  os  maxillare  superius,  the  os  palati,  the  os  malae,  the 
os  unguis,  and  the  condyloid  and  coronoid  processes  of 
the  os  maxillare  inferius;  also  there  wras  an  opening  of 
communication  from  the  orbit  to  the  dura  mater  by  an 
absorption  of  part  of  the  os  sphenoides  and  of  the  os 
frontis;  but  the  dura  mater  was  not  injured. 

In  Mr.  Heaviside's  museum  is  the  scull  of  a  woman 
who  had  a  disease  of  the  antrum,  attended  with  a  very 
great  enlargement :  in  the  course  of  the  disease,  an  ossifi- 
cation in  the  substance  of  the  tumour  took  place.  Mr. 
Heaviside,  wTho  very  kindly  favoured  me  with  drawings 
from  which  the  Plate  XXI.  and  Fig.  1,  Plate  XXII. 
were  engraved,  is  not  in  possession  of  any  accurate  histo- 
ry of  the  case.  It  occupied,  in  its  progress,  about  five 
years.  When  it  had  existed  about  four  years,  matter 
began  to  form  under  the  skin  of  the  face,  wThich,  ulcera- 
ting, was  attended  with  a  great  discharge,  under  which 
the  patient  finally  sunk. 

A  few  years  since  I  had  the  opportunity  of  observing 
the  progress  of  an  antrum  case,  in  a  respectable  gentle- 
man, Mr.  W.  The  disease  first  exhibited  itself  as  a 
tumour  above  the  molares,  occasioning  a  slight  promi- 
nence of  the  cheek.  By  the  direction  of  Mr.  Cline, 
about  once  a  fortnight  I  made  an  incision  with  a  lancet 
into  the  tumour,  which  being  attended  with  a  considera- 


322        DISEASES    OF    THE    ANTRUM    MAXILLARE. 

ble  hemorrhage,  greatly  diminished  the  tension   which 
arose  from  the  fulness  of  the  vessels. 

As  the  tumour  increased,  an  absorption  of  the  maxil- 
lary bone  took  place,  together  with  the  fangs  of  the 
teeth,*  which  becoming  loose,  were  extracted.  At  length 
the  tumour  became  so  enlarged  as  nearly  to  fill  the  mouth, 
and  by  its  projecting  of  the  cheek,  greatly  deformed  the 
countenance.  By  adhering  to  the  occasional  use  of  the 
lancet,  the  disease  was  retarded  in  its  progress  for  about 
five  years,  when  ulceration  commenced,  by  the  distress- 
ing effects  of  which  the  life  of  the  sufferer  wras  termi- 
nated in  a  few  months. 

Mr.  Cooper  is  in  possession  of  a  remarkable  case  of 
ossification  from  both  antra:  a  tumour  projected  from  each 
antrum,  which,  by  their  gradual  enlargement,  effected 
such  a  change  in  the  structure  of  the  orbits,  that  the  eyes 
considerably  projected ;  at  length  the  ossification  pro- 
ceeded upwards,  and  produced  so  much  pressure  upon 
the  brain  as  to  be  the  cause  of  the  death  of  the  patient. 

[The  character  which  the  disease  assumes  is  doubt- 
less always  determined  by  the  state  of  the  general  sys- 
tem, but  whatever  may  be  the  particular  tendency  of 
this,  it  would  probably  never  manifest  itself  in  disease 
here,  were  it  not  for  local  irritation,  and  there  is  no 
source  of  irritation  to  which  this  cavity  is  so  much 
exposed  as  that  which  arises  from  an  unhealthy  condition 
of  the  teeth,  gums  and  alveolar  processes.  Therefore, 
where  a  morbid  condition  of  these  organs  or  the  parts 
with  which  they  are  connected,  are  the  suspected  cause 
of  disease  in  this  cavity,  the  treatment  should  be  first 
directed  to  the  mouth.  If  any  of  the  teeth  in  the  upper 
jaw  beneath  the  affected  sinus  are  carious,  or  in  any  way 
productive  of  irritation  to  the  alveolar  membranes,  they 

*  Plate  XVII.  Fk.  17. 


DISEASES    OF    THE    ANTRUM    MAXILLARE.        323 

should  be  removed  at  once,  and  such  other  treatment 
afterwards  instituted  as  the  nature  of  the  case  may 
indicate. 

Disease  of  this  cavity  should  never  be  neglected,  as  it 
is  impossible  to  determine  the  character  which  it  may 
assume,  until  it  has  made  considerable  progress,  and 
involved  to  some  extent,  at  least,  the  surrounding  struc- 
tures, when,  if  it  has  not  taken  on  a  malignant  or  danger- 
ous form,  its  cure  will  be  more  difficult  and  tedious. 
When  taken  in  the  incipient  stage,  almost  every  form  of 
disease  to  which  the  maxillary  sinus  is  subject,  may,  in 
the  majority  of  cases,  be  easily  cured.  But  there  are 
some  which,  if  permitted  to  continue  until  the  neighbour- 
ing parts  have  become  involved,  bid  defiance  to  the  skill 
both  of  the  medical  and  surgical  practitioner. 

Inflammation  of  the  pituitary  or  lining  membrane,  is 
the  simplest  and  most  common  form  of  disease  to  which 
the  antrum  is  liable,  and  often  subsides  spontaneously, 
but  when  it  continues  for  a  long  time,  it  not  unfrequently 
becomes  chronic,  giving  rise  to  other  and  often  more 
aggravated  affections.  Among  the  most  common  of  these 
is  a  purulent  condition  and  accumulation  of  its  fluids,  and 
sometimes  ulceration  of  the  lining  membrane,  caries  of  its 
osseous  parieties,  fungous  and  other  varieties  of  tumour. 

The  symptoms  indicative  of  inflammation  of  the  lining 
membrane,  is  often  similar  to  those  of  some  forms  of 
tooth-ache.  For  the  most  part,  they  consist  of  a  fixed 
and  deep-seated  pain  in  the  substance  of  the  maxillary 
bone,  under  the  cheek,  extending  from  the  alveolar  ridge 
to  the  orbit.  This  is  sometimes  very  severe  and  lancina- 
ting; at  other  times  it  is  dull  and  heavy.  A  purulent 
condition  of  the  secretions  of  this  cavity,  is  sometimes 
indicated  by  the  escape  of  offensive  matter  from  the 
nostril  of  the  affected  side  when  the  patient  inclines  his 


324       DISEASES    OF    THE    ANTRUM    MAXILLARE. 

head  to  the  opposite  side.  Engorgement  may  generally 
be  suspected  from  the  formation  of  a  soft  tumour  on 
the  cheek  accompanied  by  a  sense  of  fulness.,  weight, 
redness  and  tumefaction  of  the  integuments  covering  the 
antrum.  The  tumour  generally  first  makes  its  appearance 
below  the  molar  bone,  this  being  the  point  which  generally 
but  not  always  first  gives  way. 

The  symptoms  of  abscess  are  very  similar  to  tooth-ache, 
and  ulceration  of  the  lining  membrane,  is  usually  accom- 
panied with  constant  pain,  and  when  the  patient  inclines 
his  head  to  the  opposite  side,  an  occasional  escape  of  fetid 
matter  through  the  nasal  opening,  which  sometimes  has 
flocculi  mixed  with  it.  These  not  unfrequently  choke 
up  the  natural  opening  and  cause  an  accumulation  of  the 
matter  and  a  consequent  distension  of  the  walls  of  the 
cavity.  If  the  ulcer  be  of  a  fungous  nature,  the  matter 
will  be  mixed  with  blood  and  of  a  dark  brown  or  blackish 
colour.  If  it  be  of  a  cancerous  character,  the  pain  will  be 
sharp  and  lancinating  and  the  matter  serous,  very  offen- 
sive, and  streaked  with  blood. 

Caries  and  necrosis  may  be  detected  by  perforating 
the  cavity  and  exposing  the  diseased  bone.  When  it 
occurs  in  the  alveolar  ridge,  the  gums  assume  a  livid 
appearance,  and  separate  from  the  alveoli  and  slough. 
Tumours  of  the  maxillary  sinus,  cannot  be  prognosticated 
during  their  early  stage.  It  is  not  until  after  they  have 
attained  sufficient  size  to  distend  the  cheek  or  depress 
the  roof  of  the  mouth,  that  their  existence  can  be 
ascertained. 

But  we  will  not  enlarge  upon  the  subject.  For  a 
fuller  and  more  detailed  description  of  the  diseases  of 
this  cavity  and  their  treatment,  the  reader  is  referred  to 
Part  Third,  of  the  editor's  "Principles  and  Practice  of 
Dental  Surgery."] 


CHAPTER    NINETEENTH. 

OF     LUXATION     OF     THE     LOWER     JAW. 

When  I  commenced  the  present  work,  I  had  no  inten- 
tion of  introducing  this  subject,  as  it  was  then  one  upon 
which  I  had  not  had  any  experience;  but,  having  since 
had  an  opportunity  of  attending  a  case,  I  think  there  is  a 
propriety  in  making  some  remarks  upon  this  very  disa- 
greeable accident.  The  object  I  have  chiefly  in  view,  is 
to  take  notice  of  a  mode  of  reduction,  which,  although  it 
has  been  long  recommended,  is  not  sufficiently  known; 
but  which  is  much  more  expeditious,  and  less  painful  to 
the  patient  than  the  one  commonly  adopted. 

The  structure  of  the  articulation  of  the  lower  jaw,  and 
the  nature  of  its  dislocation,  have  been  treated  with  great 
minuteness,  by  several  distinguished  anatomists.  Dr. 
Monro's  excellent  dissertation,  first  inserted  in  the  Edin- 
burgh Medical  Essays,  and  afterwards  published  in  the 
complete  edition  of  his  works,  is  not  only  comprehensive 
in  its  anatomical  description,  but  contains  the  most  ac- 
curate rules  for  the  reduction. 

The  condyloid  processes  of  the  lower  jaw  are  con- 
nected with  those  parts  of  the  temporal  bones  which  are 
situated  just  under  the  beginning  of  the  zygomatic  arch, 
and  before  the  meatus  auditorius  externus.  In  this  part 
of  each  of  the  temporal  bones,  there  is  a  cavity  adapted 
for  the  reception  of  the  condyles,  and  a  tubercle,  or 
42 


326  LUXATION    OF    THE    LOWER    JAW. 

eminence,  which,  with  the  cavity,  forms  the  articulatory 
surface.*  The  condyles  of  the  jaw,  and  the  cavities  and 
eminences  of  the  temporal  bones,  are  covered  with  a 
smooth  cartilage;  there  is  also  interposed  between  the 
condyles  and  the  temporal  bones  a  cartilage,  which  is 
movable,  and  which  contributes  greatly  to  the  steadiness 
of  the  jaw  in  all  its  motions.  These  parts  are  united  by 
a  ligament,  which  rises  from  the  circumference  of  the 
articulatory  surface  of  the  temporal  bone,  is  attached  to 
the  edge  of  the  movable  cartilage,  and  then  surrounds 
the  condyle  of  the  jaw,  and  is  inserted  into  the  neck  of 
that  bone.f 

The  structure  of  this  joint  is  admirably  adapted  to  the 
necessity  which  exists  for  a  great  variety  of  motions, 
combined  writh  strength  of  action;  it  is  peculiar  to  the 
human  subject;  all  animals  possess  the  movable  car- 
tilage, as  it  is  of  essential  service  in  diminishing  the  ef- 
fects of  friction.  Graminivorous  animals,  which  require 
an  apparatus  suited  to  the  grinding  and  minutely  dividing 
of  their  food,  possess  considerable  lateral  motion  of  the 
jaw,  whereby  they  can  move  it  from  side  to  side,  as  in 
chewing  the  cud;  and  they  reduce  their  food  to  an  im- 
palpable mass.  For  this  purpose  the  articulatory  surfaces 
on  the  temporal  bones  are  very  large,  and  permit  the 
condyles  of  the  jaw  to  perform  the  necessary  lateral  mo- 
tion. Carnivorous  animals,  which  only  tear  or  cut  their 
food,  and  require  no  grinding,  have  their  jaw  confined  to 
the  simple  hinge-formed  joint,  and  therefore  possess  only 
the  power  of  depressing  and  elevating  the  jaw. 

Man,  being  an  inhabitant  of  every  clime,  is  provided 
with  digestive  organs  suited  to  every  kind  of  food;  the 
articulation  of  his  jaw,  therefore  partakes  of  the  structure 
both  of  the  graminivorous  and  carnivorous  animal :  it  can 

*  Plate  XXVI.  Fig.  4.  fFig.3. 


LUXATION    OF    THE    LOWER    JAW.  327 

perform  lateral  motion,  and  be  confined  to  mere  elevation 
and  depression. 

When  the  mouth  is  closed,  the  condyles  of  the  jaw  are 
placed  back  in  the  cavities;  when  the  jaw  is  brought 
horizontally  forwards,  the  condyles  slide  forward  upon 
the  eminences :  this  action  may  be  performed  by  the  con- 
dyles alternately,  one  being  brought  forward  and  the 
other  held  back,  so  that  the  jaw  may  be  turned  from  side 
to  side,  as  in  the  action  of  grinding.  In  opening  the 
mouth,  the  condyles  slide  forward  upon  the  eminences; 
when  it  is  required  to  open  it  very  wide,  the  condyles 
are  brought  forward  to  the  extremity  of  the  articulatory 
surface,  and  rise  a  little,  by  passing  over  the  convexity. 
In  all  these  motions  of  the  jaw,  the  movable  cartilage  is 
of  very  great  service:  it  is  doubly  concave,  and,  by 
adapting  itself  to  the  rounded  head  of  the  condyle,  and 
that  part  of  the  articulatory  surface  which  forms  the  emi- 
nence, it  gives  steadiness  to  the  jaw  in  all  its  motions; 
without  this  cartilage,  the  jaw  would  have  been  very 
liable  to  accident.  As  convex  surfaces  can  only  touch  at 
one  point,  the  condyles  would  have  been  liable  to  slip 
back  into  the  cavity,  or  too  much  forward  and  cause  a 
dislocation. 

The  motion  of  the  lower  jaw  is  produced  by  five  pairs 
of  muscles;  these  are,  the  masseter,  temporalis,  ptery- 
goidaeus  externus,  pterygoidaeus  internus,  and  digastricus. 
The  masseter,  temporalis,  and  pterygoidaeus  internus,  act 
in  raising  the  jaw,  and  in  bringing  it  back.  The  ptery- 
goids externi  act  in  bringing  the  jaw  forward;  when 
one  only  of  these  muscles  acts,  a  lateral  motion  is  pro- 
duced, one  condyle  is  brought  forward,  while  the  other 
is  kept  back;  this  alternate  action  of  the  muscles  causes 
the  jaw  to  be  moved  from  side  to  side,  and  produces  the 


328  LUXATION    OF    THE    LOWER    JAW. 

action  of  grinding.  The  digastric  muscles  are  employed 
to  depress  the  jaw. 

The  luxation  of  the  jaw  is  commonly  occasioned  by  an 
excessive  opening  of  the  mouth;  as  in  yawning,  or  from 
a  spasmodic  action  of  the  muscles  affecting  them  at  the 
time  of  opening  the  mouth.  When  the  jaw  is  luxated,  it 
remains  wide  open,  and  the  patient  cannot  shut  it  by  any 
muscular  exertion.  The  nature  of  this  accident  will  be 
made  very  plain,  by  observing  that,  when  the  jaw  is  lux- 
ated, the  condyles  are  advanced  so  much  upon  the  ante- 
rior part  of  the  eminence,  that  they  quit  the  proper  place 
of  their  articulation;  the  muscles  then  cannot  draw  the 
jaw  back  on  account  of  the  posterior  edges  of  the  condy- 
loid processes  being  fixed  against  that  part  of  the  emi- 
nence where  it  goes  to  form  the  zygomatic  process.* 

A  person,  to  whom  this  accident  has  once  happened, 
is  liable  to  a  recurrence,  whenever  the  mouth  is  opened 
very  widely;  a  circumstance  which  renders  the  caution 
necessary,  of  supporting  the  jaw,  in  order  to  prevent  too 
great  an  extension  in  yawning,  &,c.  On  this  account 
also,  those  who  have  been  subject  to  luxation  of  the  jaw 
are  in  danger,  if  under  the  necessity  of  submitting  to  the 
extraction  of  a  tooth,  as  at  this  time  the  mouth  must  be 
opened  widely,  and  the  muscles  are  then  liable  to  be 
spasmodically  affected. 

The  mode  of  reduction  that  has  been  commonly  re- 
commended is,  to  wrap  linen  about  the  two  thumbs,  which 
are  to  be  introduced  between  the  posterior  molares;  the 
base  of  the  jaw  is  to  be  held  firmly  by  the  fingers,  and 
the  palms  of  the  hands  are  to  be  applied  to  the  chin. 
The  extension  is  made  by  pressing  the  jaw  down  at  the 
posterior  part  with  the  thumbs,  when  also  it  may  be 
pulled  a  little  forward  by  the  fingers:  at  this  time,  if  the 

•Plate  XXVI.  Fig.  2. 


LUXATION    OF    THE    LOWER    JAW.  329 

muscles  appear  to  yield,  the  chin  is  to  be  raised  by 
pressing  it  upwards  with  the  palms,  when  the  condyles 
become  disengaged  from  the  zygoma,  and  they  slide 
backward  into  their  proper  situation. 

Dr.  Monro  observes,  "that  when  the  thumbs  have  not 
force  enough  to  make  this  reduction,  his  friend  Dr. 
Simpson,  professor  of  medicine  at  St.  Andrew's,  makes 
use  of  a  round  piece  of  wood,  eight  or  nine  inches  long, 
one  end  of  which  is  cut  into  the  form  of  a  wedge,  to  in- 
troduce it  between  the  teeth  of  the  luxated  side,  with  the 
thinnest  part,  as  far  back  as  the  posterior  grinders :  wrhen, 
having  the  head  secured,  and  raising  the  chin,  he  pushes 
the  other  end  of  the  wood  upwards,  to  depress  the  back 
part  of  the  jaw  with  the  thin  end,  by  which  the  force  is 
much  greater  than  the  thumbs  can  exert." 

It  was  in  attempting  to  extract  a  tooth  that  I  had  an 
opportunity  of  attending  to  this  accident.  Last  summer, 
in  passing  through  Dorchester,  I  called  to  see  a  gentle- 
man, who,  after  the  customary  salutations,  informed  me 
there  was  a  lady  of  his  acquaintance  who  wished  to  have 
a  tooth  extracted,  and  was  at  that  instant  upon  the  point 
of  going  to  Weymouth,  to  consult  a  dentist  from  London, 
who  was  on  a  visit  there.  He  immediately  introduced 
me  to  her.  I  found  that  this  lady  had  several  times  been 
the  subject  of  luxation  of  the  jaw,  and  she  was  in  fear  lest 
that  accident  should  again  be  occasioned  by  the  opera- 
tion. The  tooth  she  wished  to  be  extracted  was  one  of 
the  dentes  sapientiae  of  the  lower  jaw.  I  consented  to 
attempt  the  operation,  but  wished  that  Mr.  Arden,  the 
surgeon,  who  had  reduced  her  jaw  two  or  three  times 
before,  should  be  present.  I  had  scarcely  fixed  the  in- 
strument upon  the  tooth,  when,  by  a  spasmodic  action  of 
the  muscles,  the  jaw  slipt  forward,  and  became  luxated. 
Attempts  were  immediately  made,  first  by  Mr.  Arden, 


330  LUXATION    OF    THE    LOWER    JAW. 

and  then  by  myself,  to  reduce   the  jaw  by   the   usual 
method  of  pressing  down  the  back  part  of  the  jaw  with 
the  thumbs,  and  raising  the  chin  wTith  the  palms  of  the 
hands:    but  neither  of  us  could  succeed,  although  very 
considerable  efforts  were  made.     I   then  happened  to  re- 
collect a  statement  once  made  to  me  by  M.  de  Chemant, 
of  his  having  been  frequently  applied  to  by  a  person  at 
Paris,  who  was   subject    to  this   accident,  and    that  he 
always  succeeded  in  reducing  the  luxation  immediately, 
by  making  use  of  a  lever  of  wood,  as  recommended  by 
Dr.  Monro.     I  then  inquired  for  a  piece  of  wood,  which 
I  could  employ  in  this  way,  and  was  so  fortunate  as  to  be 
furnished  with  a  piece  of  about  an  inch  square,  and  ten  or 
twelve  inches  long,  which  was  used  as  a  flat  ruler.     I 
introduced  this  into  the  mouth,  so  that  the  extremity  lay 
upon  the  under  molares,  and  then,  by  raising  the  other 
end  with  my  hand,  the  teeth  in  the  upper  jaw  became 
the  fulcrum.     The  jaw  on  that  side  was  then  depressed 
at  the  posterior  part,  when  the  condyle  immediately  passed 
over  the  edge  of  the  eminence.     I  then  applied  the  lever 
to  the  other  side  of  the  jaw,  and  disengaged  that  in  like 
manner,  when  the  muscles  instantly  drew  the  jaw  back 
into  its  proper  situation. 

The  quickness  with  which  the  reduction  was  performed, 
by  this  means,  gave  great  pleasure,  as  the  lady  had 
sometimes  been  a  very  long  time  before  reduction  in  the 
common  mode  could  be  effected.  Once,  when  at  a 
distance  from  home,  this  accident  happened  to  her,  and 
she  was  nearly  two  hours  submitting  to  attempts,  before 
reduction  could  be  effected. 

In  addition  to  this  case,  I  have  been  informed  by  Mr. 
Heaviside,  that  he  was  lately  sent  for  to  reduce  a  luxation 
of  the  jaw,  which  had  occurred  to  a  lady,  from  merely 
opening  her  mouth  widely,  to  have  her  teeth  scaled. 


LUXATION    OF    THE    LOWER   JAW.  331 

To  prevent  this  accident  from  happening  in  the  extrac- 
tion of  a  tooth;  to  persons  who  have  previously  been 
subject  to  a  luxation  of  the  jaw,  I  have  contrived  a  band- 
age, which  will  insure  the  safety  of  the  patient  during  the 
operation.  This  bandage  consists  of  a  piece  of  leather, 
formed  so  as  to  receive  the  chin,  and  a  strong  cap,  that 
may  be  placed  upon  the  top  of  the  head,  which  are  con- 
nected by  two  straps  on  each  side :  it  is  to  be  fixed  when 
the  mouth  is  opened  to  a  certain  degree,  with  the  condyles 
as  far  back  as  possible :  the  cap  is  then  to  be  put  on  the 
posterior  part  of  the  crown  of  the  head,  and  the  leather 
being  applied  to  the  chin,  the  straps  are  to  be  buckled 
tight,  when  it  will  not  be  possible,  by  any  effort,  to 
advance  the  jaw  so  much  as  to  endanger  its  luxation,  and 
the  tooth  may  be  extracted  with  safety.* 

*  Plate  XXVI.  Fig.  5. 


EXPLANATION  OF  PLATES 


PART  SECOND. 


43 


PLATE  XVI. 

Figs.  1,  2,  3,  4,  5,  6.  Represent  the  progress  of  caries. 
On  the  side  of  Fig.  1,  is  a  dark  appearance, 
resembling  an  opaque  spot  upon  the  enamel: 
in  Fig.  2,  the  caries  has  produced  a  cavity: 
Fig.  3,  is  the  section  of  a  molaris,  to  show  that 
the  caries  proceeds  to  the  natural  cavity  in  the 
tooth:  Fig.  4,  a  molaris  with  caries  in  the 
centre :  Fig.  5,  the  decay  much  increased :  and 
Fig.  6,  the  whole  of  the  crown  being  removed, 
the  fangs  only  are  left. 

Fig.  3  a.  The  section  of  a  molaris,  in  which  there  was 
a  superficial  decay;  a  dark  mark  is  seen  extend- 
ing from  the  caries  to  the  cavity  in  the  tooth, 
showing  the  direction  of  the  death  of  the  bone 
of  the  tooth. 

Fig.  4  a.  A  molaris  apparently  quite  sound;  but,  on 
being  sawn  into,  a  considerable  caries  was 
formed  in  the  body  of  the  tooth. 

Fig.  5  a.  The  enamel  of  a  molaris  which  separated  from 
the  tooth,  in  consequence  of  the  bony  part 
being  destroyed  by  caries. 

Fig.  6  a.  A  stump  protruded  by  the  closing  of  the 
socket,  until  it  was  held  only  by  the  gum. 

Fig.  7.  The  incisores  of  a  child  decayed,  the  points  of 
the  fangs  ulcerated  through  the  gums. 


336  PLATE    XVI 

Fig.    8.     An  exfoliation  from  the  upper  jaw,  containing 

two  incisores  and  a  cuspidatus:  the  disease  was 

caused    by  the  inflammation   attendant  on   the 

decay  in  the  lateral  incisor. 
Fig.    9.     An  exfoliation  from  the  under  jaw,  from  the 

effects  of  caries  in  a  molaris. 
Fig.  10.     The  effects  of  an  abscess  at  the  point   of  a 

stump.     A  considerable  portion  of  the  alveolar 

process  is  absorbed. 
Fig.  11.     The  point  of  a  stump  with  a  membranous  bag 

attached  to  it;  in  which  matter  was  contained. 
Fig.  12.     Two  molares  extracted  on  account  of  exostosis 

of  the  fangs. 
Fig.  13.     Examples  of  exostosis  of  the  fangs  in  several 

teeth. 


Fig. 

1. 

Fig. 

2. 

Fig. 

3. 

PLATE  XVII. 

Caries  on  the  sides  of  the  incisores. 
Represents  the  teeth  with  the  caries  filed  out. 
The  appearance  of  the  teeth  when  denuded  of 

the  enamel. 
Fig.    4.     A  deep  notch  formed  at  the  necks  of  the  teeth 

by  the  denuding  process. 
Fig.    5.     Two  cuspidati,  with  deep  notches,  from  the 

same  cause. 
Fig.    6.     Examples  of  diseases  in  the  fang,  resembling 

spina  ventosa. 
Figs.    7,  8,  9,  10,  11,  12,   13,  14,  15,  16.     Diseases  of 

the  fang,  resembling  necrosis  in  bones. 
Figs.  17,  17.     Two  molares,  the  fangs  of  which  were 

absorbed  in  consequence  of  a  tumour  formed 

in  the  antrum. 
Fig.  18.     A    tooth   which    had   been    transplanted,  the 

fang  of  which  was  absorbed  in  a  most  cu- 
rious manner. 
Fig.  19.     Two  incisores  of  the  under  jaw,  the  fangs  of 

which    were   absorbed,    in   consequence   of 

disease  in  the  socket. 


PLATE   XVIII. 

Fig.  1.  A  central  incisor  protruded  by  the  closing  of 
the  socket  at  the  extremity  of  the  fans;. 

Fig.  2.  The  two  lateral  incisores  protruded  from  the 
same  cause. 

Fig.  3.  A  great  separation  of  the  central  incisores 
from  an  exostosis  of  the  transverse  alveolar 
process. 

Fig.  4.  Irregularity  of  the  teeth  arising  from  disease 
of  the  sockets. 

Fig.  5.  The  appearance  of  the  teeth  under  absorption 
of  the  gums  and  alveolar  processes. 

Fig.  6.  Absorption  of  the  gums  and  sockets,  leaving 
the  fangs  of  the  teeth  uncovered  and  black. 

Fig.  7.  Absorption  of  the  gums  and  sockets  of  two 
teeth  in  the  under  jaw. 

Fig.  8.  The  same  disease  in  the  gums  and  sockets  of 
three  teeth  in  the  upper  jaw. 

Fig.  9.  Two  teeth  fractured  at  the  points;  the  frac- 
ture not  having  extended  into  the  cavities, 
the  dotted  lines  show  how  much  may  be 
filed  off  to  make  them  even. 

Fig.  10.  Two  teeth  fractured  by  a  blow;  the  cavities 
in  each  were  exposed,  and  caused  great  in- 
flammation; a points  to  the  cavities. 

Ftg.  11.  Two  central  incisores  fractured  by  a  blow; 
the  remainder  of  the  crowns  were  filed  off, 
and  the  teeth  pivoted  to  the  fangs. 


PLATE  XIX. 

Fig.  1.  Blacky  hard  tartar,  collected  about  the  necks 
of  the  teeth. 

Fig.  2.  Represents  the  yellowish  coloured  tartar,  and 
the  teeth  much  stained. 

Fig.  3.  The  manner  in  which  the  progressive  accu- 
mulation of  tartar  causes  the  loss  of  teeth. 

Figs.  4,  5,  7,  8,  9,  10,  11,  12,  13.  Examples  of  consid- 
erable accumulation  of  tartar  about  different 
teeth. 

Fig.  6.  A  piece  containing  six  artificial  teeth,  about 
which  a  most  prodigious  quantity  of  tartar 
was  suffered  to  accumulate,  also  a  larg3 
mass  about  the  cuspidatus;  the  whole,  when 
quite  dry,  weighed  three  drachms  and  a 
half. 

Fig.  14.  A  large  accumulation  on  the  side  of  the  mo- 
lares. 

Fig.  15.  A  large  quantity  collected  on  the  posterior 
surface  of  the  under  incisores. 

Fig.  16.  A  similar  accumulation  on  the  anterior  surface 
of  the  incisores. 


PLATE    XX. 

Fiu.  1       An  exfoliation  of  the  alveolar  processes  . :  the 

temporary  tec::..  g     rom    a    scro- 

fulous disease  in  the  gums. 

Fig.  2.     An  exfoliation  c:       r-bone  and  teeth,  in  con- 

the    exhibition   of    too   much 
mercury. 

Fig.  3.     The   greatej    part   oi  the  under  jaw.  which  ex- 
foliated in  con-  fk  lent  salivation. 

Figs.  4.  5.  Exfoliations  oi  nearly  the  whole  of  the  m 

".  and    a   piece   of  the    uj    ei     aw.  pro- 
duce., by  ;he  small-pox. 

Fk..-.  •.'■.  7.  Exfoliations  from  the 

cans  :     sm 

Fig.  B.     An     Los    a£ 


PLATE   XXI. 

The  skull  of  a  female  who  had  a  disease  of  the  antrum, 
which  produced  an  ossific  tumour,  in  the  possession  of 
John  Heaviside,  Esq. 

a.     The  cartilage  of  the  nose  unaffected  by  the 
disease. 
bbbbb.     The  extent  of  the  bony  tumour. 

c.  The  bony  matter  that  filled  up  the  roof  of 
the  mouth. 
ddddddd.  Several  teeth  pushed  out  of  their  proper 
situations;  the  sockets  of  which  are 
greatly  absorbed.  The  dark  parts  on  the 
surface  of  the  tumour  are  chasms  made 
by  the  matter  under  the  integuments. 


44 


PLATE   XXII. 

Fig.  1.     The  appearance  of  the  face  of  the  person  who 

was  the  subject  of  the  antrum  case,  described 

in   Plate   XXI.    before   any  ulceration    took 

place. 
Fig.  1.     The  profile  of  the  face  of  a  young  gentleman 

who  had  a  distorted  growth  of  the  upper  jaw, 

combined  with  harelip. 
Fig.  2.     The  piece  of  bone,  with  three  teeth,  which  was 

sawn  off. 
Fig.  3.     The  appearance  of  the  face  after  the  operation 

was  completed. 
Fig.  4.     Represents  the  teeth  of  a  Malay  Indian,  which 

are  filed  on  the  anterior  surface;  the  central 

incisores  were  filed  so  nearly  into  the  cavities, 

as  to  be  the  cause  of  caries. 
Fig.  5.     Represents  the  teeth  of  an  Abyssinian  Negro, 

filed  into  a  pointed  form. 
Fig.  6.     The   key  instrument,  having   three   places   in 

which  the  claw  may  be  fixed:  in  this  figure, 

the  claw  is  placed  beyond  the  bolster. 
Fig.  7.  The  claw  is  placed  in  the  usual  position. 
Fig.  8.     The  claw  is  placed  before  the  bolster. 


PLATE   XXIII. 

Fig.  1.  The  key  instrument,  with  the  claw  beyond  the 
bolster,  and  fixed  as  in  the  extraction  of  the 
dens  sapientiae  in  the  lower  jaw. 

Fig.  2.  The  key  instrument,  with  the  claw  before  the 
bolster,  and  fixed  as  in  the  extraction  of  a 
bicuspis  in  the  lower  jaw. 

Fig.  3.  The  key  instrument,  with  the  claw  opposite  to 
the  bolster,  and  fixed  as  in  the  extraction  of 
the  molares. 

Fig.  4.  The  key  instrument  as  fixed  in  the  most  proper 
manner. 

Fig.  5.  Represents  the  possible  consequence  of  using 
too  large  a  claw,  or  of  placing  the  bolster  too 
low;  the  tooth  is  liable  to  be  broken  in  the 
direction  of  the  dotted  line. 

Fig.  6.  Represents  the  possible  consequence  of  using 
too  small  a  claw;  the  tooth  is  liable  to  be 
broken  in  the  direction  of  the  dotted  line, 
across  the  neck  of  the  tooth,  or  the  claw  will 
be  broken  in  the  centre  of  the  curve. 

Fig.  7  The  molares  of  the  upper  jaw,  which  were  torn 
away  by  an  improper  mode  of  attempting  to 
extract  one  which  was  decayed. 

Fig.  8.  A  dens  sapientiae,  with  a  large  piece  of  jaw- 
bone, broken  away  by  an  unskilful  application 
of  the  instrument. 

Fig.  9.  Represents  the  manner  in  which  teeth  incline 
towards  each  other,  after  an  intermediate  one 
has  been  extracted. 


PLATE  XXIV 


FORCEPS  FOR  THE  EXTRACTION  OF  THE  TEETH,  AS  IMPROVED 
BY  THE  EDITOR. 


Fig.  1.  Straight  forceps  for  the  extraction  of  the  su- 
perior incisores  and  cuspidati. 

Fig.  2.  Forceps  for  the  extraction  of  the  bicuspides 
and  dentes  sapiential. 

Fig.  3.  Dr.  S.  P.  Hullihen's  compound  screw-forceps, 
for  the  extraction  of  the  roots  of  the  superior 
incisores  and  cuspidati. 

Fig.  4.  Forceps  for  the  extraction  of  the  dentes  sapi- 
ential of  the  upper  jaw. 


PLATE  XXV. 

FORCEPS  FOR  THE  EXTRACTION  OF  THE  TEETH,  AS  IMPROVED 
BY  THE  EDITOR. 

Fig.  1.  Forceps  for  the  extraction  of  the  inferior  mo- 
lares.  They  will  apply  with  equal  facility  to 
either  side  of  the  mouth. 

Fig.  2.  Forceps  for  the  extraction  of  the  right  superior 
molares. 

Fig.  3.  Forceps  for  the  extraction  of  the  left  superior 
molares. 

Fig.  4.  Forceps  for  the  extraction  of  the  roots  of  teeth 
and  the  lower  incisores. 


PLATE  XXVI. 

Fig.  1.  The  appearance  of  the  jaw-bones  when  the 
whole  of  the  alveolar  processes  have  been 
absorbed. 

Fig.  2.  The  position  of  the  lower  jaw  when  luxated;  the 
condyloid  processes  are  advanced  so  much 
over  the  articulatory  eminence,  that  it  is  pre- 
vented from  returning,  by  resting  against  the 
lower  part  of  the  zygomatic  arch. 

Fig.  3.  A  section  of  the  temporal  bone  with  the  con- 
dyloid process  of  the  lower  jaw,  representing 
the  ligament  and  movable  cartilage. 

Fig.  4.  A  section  of  the  temporal  bone  and  part  of  the 
lower  jaw,  representing  the  head  of  the 
condyloid  process  in  the  cavity;  the  articula- 
tory eminence,  or  tubercle,  being  before  the 
condyle. 

Fig.  5.  Represents  a  mouth  opened,  and  a  bandage 
applied  to  keep  the  jaw  back,  and  prevent 
luxation  during  the  extraction  of  a  tooth. 


PLATE   XXVII. 

Represents  the  case  of  Sarah  Dulwich. 
Fig.  1.     The  appearance  of  her  face  when  first  admitted 

into  Guy's  Hospital. 
Fig.  2.     The  appearance  about   two  months  after   her 
admission,  when  the  tumour  began  to  pro- 
trude from    the    mouth,  having  the   surface 
ulcerated. 
Figs.  3,  4.  The  appearance  a  short  time  before  her  de- 
cease, viewed  laterally  and  in  front. 
*#*  The  unfortunate  sufferer  was  alive  when  the  former 
account    of  her  case,  as  before  inserted,  was  in  the 
press,  rendering  it  impossible  in  the  body  of  the  work 
to  detail  all  the  particulars.     The  following  account  is 
taken  from  the  notes  of  Mr.  Astley  Cooper,  who  pos- 
sesses the  preparation  of  this  most  extraordinary  dis- 
ease. 


Sarah  Dulwich,  set.  13,  scrofulous  constitution,  was 
admitted  into  Guy's  Hospital  on  April  8,  1812,  with  a 
large  tumour  under  the  left  cheek,  which  first  made  its 
appearance  twelve  months  previously,  in  the  form  of  a 
small  tumour  of  the  gum  upon  the  lower  jaw,  and  at  that 
time  not  painful. 


348  PLATL    XXVII 

At  the  time  of  her  admission,  the  tumour  occupied  the 
whole  of  the  left  cheek;  it  was  globular;  it  felt  irregular 
under  the  integuments;  it  projected  below  the  jaw,  and 
extended  from  the  cuspidatus  of  the  lower  jaw  on  the 
right  side,  irregularly  under  the  tongue,  which  it  had 
thrust  close  to  the  right  cheek,  and  consequently  ren- 
dering speech  difficult  and  indistinct;  internally  its  sur- 
face was  irregular,  hard,  and  unyielding;  it  was  in  a 
superficial  state  of  ulceration  from  the  pressure  of  the 
teeth  of  the  upper  jaw  on  the  left  side.  For  six  months 
previously  from  its  rising  above  the  teeth  of  the  lower 
jaw  it  prevented  the  approximation  of  the  jaws,  the  lips 
remaining  an  inch  and  a  half  or  two  inches  apart.  The 
discharge  from  the  ulcerated  surface  was  sometimes 
bloody  and  offensive  to  the  smell. 

Upon  viewing  the  tumour  externally  it  reached  from 
under  the  edge  of  the  orbit,  extending  by  the  side,  and 
pushing  up  the  left  nostril,  and  around  to  the  ear,  forming 
an  immense  extended  tumour  even  down  to  the  fore  part 
of  the  chin;  it  was  at  least  half  the  size  of  the  head,  the 
skin  in  some  places  had  a  slight  blush  on  it,  and  here  and 
there  the  veins  were  seen  of  considerable  size  running 
over  its  surface. 

Deglutition  was  extremely  difficult  and  painful  in  con- 
sequence of  the  pressure  of  the  tumour  against  the  teeth 
of  the  upper  jaw. 

Half  the  upper  jawT,  together  with  the  teeth,  from  the 
pressure  of  the  tumour,  were  pushed  towards  the  oppo- 
site side. 

The  only  cause  she  can  assign  for  the  disease  is,  that 
she  was  subject  to  constant  tooth-ache  in  the  two  molar 
teeth  of  the  lower  jaw,  for  two  or  three  months  previous 
to  the  appearance  of  the  tumour  on  the  gum.  In  other 
respects  her  health  is  good. 


PLATE    XXVII.  349 

The  tumour  continued  increasing  in  size,  and  dis- 
torting the  countenance.  About  two  or  three  months 
after  admission,  it  began  to  press  forward  and  to  hang 
out  of  the  mouth,  and  about  this  time  she  began  to  be 
troubled  with  a  constant  discharge  of  saliva  over  the 
tumour,  together  with  a  profuse  discharge  of  fetid  bloody 
matter. 

About  five  or  six  months  after  her  admission  the  tu- 
mour and  lower  jaw  became  extremely  painful,  and  small 
pieces  of  the  jaw  began  to  exfoliate  from  under  the  tu- 
mour, and  from  that  time  to  her  demise  about  ten  or 
twelve  pieces  of  bone  exfoliated. 

She  died  in  about  eleven  months  after  admission. 


DISSECTION. 

The  tumour  was  found  to  be  growing  from  the  inner 
and  left  side  of  the  lower  jaw. 

It  had  thrust  the  tongue  backwards  and  to  the  right 
side,  so  that  its  apex  reached  only  to  the  cuspidatus 
tooth. 

The  upper  edge  of  the  lower  jaw  was  thrust  forwards, 
and  the  teeth,  instead  of  being  opposed  to  those  of  the 
upper  jaw,  had  their  points  thrust  forwards  and  out- 
wards. 

One  of  the  molares  on  the  left  side  was  carried  by  the 
tumour  in  which  it  was  imbedded  to  the  right  side  under 
the  apex  of  the  tongue. 

On  cutting  into  the  disease  it  was  found  white  in 
colour,  firm,  and  of  a  consistence  approaching  to  the 
nature  of  cartilage,  but  not  quite  so  firm;  but  under  this 
45 


350  PLATE    XXVII. 

cartilage,  and  close  to  the  jaw,  the  basis  of  the  tumour 
was  composed  of  large  masses  of  bone. 

The  periosteum  of  the  jaw  covered  the  tumour. 

This  disease  was  therefore  an  exostosis  of  the  lower 
jaw,  but  its  surface  remained  cartilaginous  whilst  its  basis 
was  composed  of  bone. 

Astley  Cooper. 

October  31,  1813. 


Plan   16. 


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mr-* 


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Plate  26. 


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I '5 Duals  LiTh,  Phdad 


Plate  27. 


Fig.  I 


Fig.  2. 


Rq   4 


On  siont  by  A  Ncwsixm 


P S Duval's  Litii  Phtlcut 


PART   III. 


ARTIFICIAL    TEETH,    OBTURATORS    AND    PALATES. 


PART  THIRD 


CHAPTER    FIRST. 


ARTIFICIAL    TEETH. 


[Greater  improvements  have  been  made  in  the  con- 
struction and  application  of  artificial  teeth,  during  the 
last  quarter  of  a  century,  than  in  any  other  branch  of 
dentistry.  Previously  to  this  time,  and  even  down  to  a 
much  later  period,  artificial  teeth,  for  the  most  part,  were 
carved  from  blocks  of  ivory  and  fastened  in  the  mouth  by 
ligatures  to  the  adjoining  teeth,  or  by  springs  constructed 
in  the  awkwardest  and  most  bungling  manner.  It  is 
true,  the  invention  of  porcelain  teeth,  had,  at  a  much 
earlier  date  been  made,  but  their  manufacture  had  not 
been  brought  to  a  sufficient  degree  of  perfection,  to  ren- 
der them  at  all  desirable  as  substitutes  for  the  loss  of  the 
natural  organs.  Some  idea  may  be  formed  of  the  state 
of  this  department  of  practice,  at  the  time  of  the  publi- 
cation of  this  work,  by  the  remarks  of  the  author  upon 
the  subject,  which  the  editor,  in  order  to  preserve  the 
whole  of  the  original  work,  will  give  entire. 


354  ARTIFICIAL    TEETH. 

He  says]  "upon  this  subject,  1  cannot  attempt  to  do 
more  than  give  a  very  general  statement,  it  being  impos- 
sible to  teach  a  mechanical  art,  in  any  other  way  than  by 
manual  practice. 

The  inconvenience  which  attends  the  loss  of  teeth,  in 
respect  to  enunciation,  as  well  as  mastication,  renders  the 
introduction  of  some  substitute  very  desirable.  For  this 
purpose  artificial  teeth  are  invented,  which  not  only 
remedy  the  effects  above-mentioned,  but  also  preserve 
the  symmetry  of  the  mouth. 

Artificial  teeth  are  most  commonly  formed  from  the 
tooth  of  the  hippopotamus,  which  is  the  most  dense  os- 
seous substance  with  which  we  are  acquainted.  Of  late 
years,  they  have  also  been  made  of  a  porcelain  compo- 
sition, which  has  been  introduced  by  M.  de  Chemant: 
this  gentleman's  invention  merits  much  commendation, 
as  it  affords  a  more  durable  substance  for  those,  who, 
from  acidity,  or  some  peculiar  property  in  the  fluids  of 
the  mouth,  destroy  artificial  teeth,  made  of  osseous  sub- 
stances. However,  these  teeth  do  not  sufficiently  re- 
semble nature,  and  considerable  allowance  must  be  given 
to  the  statements  of  an  author  disposed  to  regard  his  own 
invention  as  meriting  a  decided  preference. 

The  manufacture  of  artificial  teeth  require  a  profi- 
ciency in  mechanical  art  which  can  only  be  acquired  by 
much  patient  labour,  and  it  is  the  exactness  with  which 
they  are  adapted  to  the  mouth,  and  the  ease  with  which 
they  can  be  worn,  that  constitute  their  chief  excellence. 
In  order  to  be  able  to  prepare  an  artificial  tooth,  a  model 
of  the  space  to  be  filled  up  must  be  taken  in  wax;  from 
which  a  cast  in  plaster  of  Paris  may  be  made.  The 
impression  of  the  mouth  in  the  wax  being  the  reverse, 
will  cause  the  plaster  of  Paris  to  acquire  the  exact  repre- 
sentation of  the  person's  mouth.     Having  thus  obtained  a 


ARTIFICIAL    TEETH.  355 

model,  the  substance  designed  to  be  the  artificial  tooth 
must  be  fitted  with  great  nicety,  and  be  so  formed  as  to 
correspond  with  the  other  teeth.  The  same  general  di- 
rections apply  to  the  formation  of  more  teeth  than  one, 
and  so  even  to  a  complete  set. 

Artificial  teeth  are  made  secure  by  fastening  them  to 
the  adjoining  teeth  by  ligatures  of  silk,  Indian  weed, 
commonly  called  silk-worm  gut,  or  fine  gold  wire.  If 
the  teeth  are  made  to  fit  very  correctly,  a  slight  fasten- 
ing will  be  sufficient;  and,  in  all  cases,  persons  should 
avoid  tying  ligatures  very  tightly,  as  then  they  are  very 
liable  to  create  pain,  and  do  mischief.  In  other  instances, 
they  are  fastened  by  means  of  gold  springs. 

The  foregoing  remarks  apply  only  to  those  cases  in 
which  the  teeth  have  been  extracted,  or  being  loose, 
have  dropped  out:  but,  when  teeth  are  lost  by  caries, 
another  mode  of  inserting  artificial  teeth  is  adopted. 

The  incisores  and  cuspidati  of  the  upper  jaw  are  very 
frequently  affected  with  caries,  and  the  crowns  of  the 
teeth  decay,  so  as  to  leave  little  more  than  the  fangs  in 
the  sockets.  When  the  teeth  are  in  this  situation,  if 
there  be  no  disease  in  the  socket,  new  teeth  may  be  fixed 
to  the  fangs  of  the  decayed  ones,  without  any  attachment 
to  the  other  teeth  being  required.  This  operation  is  to 
be  performed  as  follows:  All  the  ragged  or  carious  re- 
mains of  the  crown  of  the  tooth  are  to  be  filed  away 
close  to  the  gum;  the  hole  in  the  fang,  which  forms  the 
natural  cavity,  is  then  to  be  prepared  for  receiving  the 
pivot,  by  which  the  new  tooth  is  to  be  fastened ;  this  is 
done  by  passing  a  small  instrument,  called  a  broach,  into 
the  cavity,  and  drilling  it  into  a  smooth  round  hole. — 
The  fang  being  thus  prepared,  the  crown  of  a  human 
tooth,  corresponding  with  the  one  that  has  been  filed  off, 
is  to  be  fitted  to  .he  fang,  a  hole  is  then  to  be  drilled, 


3dG  artificial  teeth 

and  a  piece  of  gold  wire  screwed  firmly  into  it;  the  wire 
being  left  of  a  length  equal  to  the  hole  in  the  fang,  and 
filed  to  the  exact  size,  is  to  be  introduced,  and,  being 
made  tight,  it  may  continue  for  many  years  without  occa- 
sioning any  trouble,  or  requiring  any  repair.  In  this 
mode,  several  teeth  belonging  to  the  same  person  may 
be  replaced,  which  cannot  be  discerned  upon  the  most 
minute  inspection. 

Much  prejudice  has  been  excited,  without  foundation, 
against  the  use  of  human  teeth,  in  the  manner  as  above 
described,  on  account  of  various  alarming  symptoms  hav- 
ing attended  the  former  practice  of  transplanting.  No 
person  can  be  a  greater  enemy  to  that  operation  than 
myself,  but  there  is  a  most  essential  difference  between 
the  two  modes  of  practice;  for,  in  that  which  is  recom- 
mended, we  only  use  a  piece  of  tooth,  which  may  be 
considered  precisely  in  the  same  condition  as  any  com- 
mon piece  of  bone.  No  tooth  formed  by  art  can  be 
compared  to  a  natural  tooth,  fixed  in  this  manner;  as 
artificial  teeth  must  differ,  in  some  degree,  from  human 
teeth,  both  in  colour  and  form. 

Natural  teeth  connected  to  a  plate  of  gold,  or  a  base 
made  of  the  tooth  of  the  hippopotamus,  may  be  fixed  in 
the  same  manner  as  artificial  teeth.  This  is  a  very  neat 
mode  of  supplying  the  loss  of  teeth,  and  cannot  be  de- 
tected, by  any  difference  in  their  colour  or  form,  from  the 
natural  set. 

It  was  Mr.  Hunter  who  introduced  and  recommended 
the  practice  of  transplanting  teeth;  and,  under  his  imme- 
diate inspection,  it  was  carried  on  to  a  great  extent.  In 
his  treatise  on  the  diseases  of  the  teeth,  he  goes  into  the 
subject  at  great  length,  and  he  admits  it  to  be  a  difficult, 
uncertain,  and  often  an  unsuccessful  operation. 

In  the  course  of  the  practice  many  very  disagreeable 


ARTIFICIAL    TEETH.  357 

and  alarming  symptoms  attended  some  of  the  cases.  In 
a  later  work,  Mr.  Hunter  endeavoured  to  diminish  the 
disrepute  into  which  a  practice  had  fallen  that  he  was 
naturally  partial  to,  from  its  being  of  his  own  inven- 
tion, by  accounting  for  all  the  symptoms  which  occurred, 
on  the  principal  of  irritation  exciting  deranged  sympa- 
thies. That  the  mere  irritation  of  a  foreign  body,  as  the 
tooth  of  one  person  inserted  into  the  alveolus  of  another, 
will  occasion  many  extraordinary  sympathies,  independent 
of  any  infection,  may  readily  be  conceived.  I  have  been 
informed  by  Dr.  Jenner  of  a  person  who  had  blotches  on 
the  skin,  from  the  irritation  which  followed  the  replacing 
of  a  tooth  into  the  same  socket  from  which  it  had  been 
extracted. 

However,  the  ill  success  and  unfortunate  consequences 
that  sometimes  occurred,  have  caused  the  practice  to  be 
abandoned  for  many  years  past.  The  other  modes  of 
supplying  the  loss  of  teeth  are  so  unexceptionable,  and 
invariably  successful,  that  we  have  no  reason  to  regret 
the  failure  of  the  practice  of  transplanting.  I  might 
indeed  have  observed,  that  this  operation  involved  in  it  a 
defect  of  the  moral  principle,  as  one  person  is  injured 
and  disfigured,  in  orde'r  to  contribute  to  the  luxury  and 
convenience  of  another. 

In  Plate  XVII.  Fig.  18,  is  the  representation  of  a 
transplanted  tooth,  which  was  worn  by  a  gentleman 
eleven  years;  it  had  never  been  quite  fast,  but,  during 
the  last  two  or  three  years,  it  had  become  very  loose,  at 
length  the  crown  broke  off,  and  left  the  fang  in  the  gum : 
on  extracting  it  I  found  it  to  have  been  absorbed  all 
around  in  the  most  curious  manner,  and  contrary  to  the 
common  mode  in  which  the  absorbents  act  upon  the 
fangs  of  teeth,  which  is  to  begin  at  the  point,  and  extend 
towards  the  neck.  In  this  way  the  absorbents,  as  if  con- 
46 


358  ARTIFICIAL    TEETH. 

scious  that  this  tooth  was  an  intruder,  exerted  their 
utmost  power  to  eat  it  out,  rather  than  permit  its  con- 
tinuance." 

[The  materials  used  for  and  the  manner  of  applying 
artificial  teeth  at  the  time  this  work  was  written,  were, 
for  many  reasons,  exceedingly  objectionable.  To  be  both 
serviceable  and  desirable,  they  should  not  only  be  ap- 
plied in  such  a  manner  as  not  to  exert  an  unhealthy 
influence  upon  the  parts  on  which  they  rest,  or  be,  in 
any  wray,  productive  of  injury  to  the  remaining  natural 
teeth,  if  there  be  any,  but  they  should  also  correspond  in 
shape  and  appearance  with  those  which  they  replace, 
and  be  incapable  of  being  acted  upon  by  the  fluids  of 
the  mouth,  whether  in  a  healthy  or  diseased  condition. 
When  badly  applied  or  of  an  improper  material,  they  are 
not  only  both  an  annoyance  and  nuisance,  but  are  pro- 
ductive of  vastly  more  injury  than  benefit,  and  notwith- 
standing the  high  comparative  state  of  perfection  to  which 
this  department  of  the  art  has  been  brought,  and  is  at 
present  practiced  by  a  few,  nineteen-twentieths  of  the 
artificial  teeth  worn,  are  of  this  description,  or  at  least, 
so  far  as  it  regards  the  manner  of  their  application. 

The  demand  for  artificial  teeth  has  become  so  general, 
since  the  improved  manner  of  their  construction  and  ap- 
plication, has  so  fully  established  their  utility,  that  every 
one  having  the  most  meagre  pretensions  to  a  knowledge 
of  dentistry,  is  now  called  upon  for  them,  when,  in  reality, 
not  more  than  one  in  twenty  possesses  either  the  judg- 
ment or  skill,  never  having  been  properly  instructed  in 
the  art,  to  construct  or  execute,  in  a  proper  manner,  a 
piece  of  dental  mechanism.  Neither  mechanical  ability 
to  execute  nor  a  judgment  sufficiently  enlightened  to 
design  the  plan  most  proper  for  the  construction  and 
application  of  artificial  teeth  in  the  various  cases  which 


ARTIFICIAL    TEETH.  359 

are  constantly  presenting  themselves,  separately,  consti- 
tutes the  qualifications  requisite  for  a  practitioner  in  this 
department.  Both  should  unite  in  the  same  person,  and 
in  addition  to  which,  a  correct  knowledge  of  the  reme- 
dial indications  of  the  various  morbid  conditions  of  the 
several  parts  and  structures  of  the  mouth,  is  indispensa- 
ble; for,  it  is  never  strictly  proper,  to  apply  artificial 
teeth  when  the  remaining  teeth,  gums,  or  alveolar  pro- 
cesses are  in  a  diseased  condition. 

And  as  indispensable  as  are  these  various  branches  of 
knowledge  even  to  a  mechanical  dentist,  there  are  hun- 
dreds of  practitioners  in  the  country,  who  have  made  but 
little,  if  any  proficiency  in  either;  and  it  is  to  the  very 
limited  professional  acquirements  of  most  of  those  en- 
gaged in  the  exercise  of  the  duties  of  the  art,  that  so  few 
of  the  artificial  teeth  worn  even  at  the  present  day,  are 
not  only  worth  nothing  at  all,  but  a  source  of  constant 
annoyance  and  actual  injury  to  those   who  wear  them. 

Of  the  various  materials  which  have  been  employed 
for  artificial  teeth,  the  porcelain  is  almost  the  only  sort,  at 
present,  used.  The  perfection  in  wThich  these  have  been 
manufactured  during  the  last  ten  years,  and  especially  in 
the  United  States,  has  secured  for  them  a  decided  pre- 
ference over  every  other  description  of  artificial  teeth. 
They  are  now  made  to  resemble  so  closely  the  natural 
organs,  as  to  render  their  detection  when  placed  in  the 
mouth,  exceedingly  difficult.  But  resemblance  to  the 
natural  teeth,  is  not  their  only  merit.  Unlike  all  osseous 
substances,  they  never  change  in  colour,  or  not  mate- 
rially, nor  are  they  liable  to  be  acted  upon  by  the  secre- 
tions of  the  mouth.  They  can  also  be  more  neatly  and 
firmly  secured  in  the  mouth  than  any  other  dental  sub- 
stitute. 

Although  there  are  many  dentists  engaged  in  the  manu- 


360  ARTIFICIAL    TEETH. 

facture  of  porcelain  teeth,  it  does  not  necessarily  consti- 
tute any  part  of  his  duties.  It  is  a  distinct  business,  and 
it  is  one  which  has  been  carried  on  for  the  last  ten  or 
twelve  years,  in  the  United  States,  very  extensively. 
During  this  period,  one  establishment,  the  editor  has 
been  informed,  has  sold  annually,  from  ten  to  twenty-five 
thousand  dollars  worth. 

So  much  more  highly  esteemed  are  the  American  por- 
celain teeth  than  the  European,  that  they  are  now  exten- 
sively used  both  in  Great  Britain  and  France,  as  well  as 
in  other  foreign  countries.  It  is  but  just,  however,  to 
say,  that  these  teeth  so  far  as  it  regards  shape  and  resem- 
blance to  the  natural  organs,  are  at  present  manufactured 
in  very  great  perfection  in  London.  The  editor  has  seen 
some  very  beautiful  specimens  manufactured  by  Mr.  Ash, 
of  that  city. 

The  porcelain  teeth  manufactured  in  France,  although 
very  strong,  and  seldom  break  under  the  blow-pipe,  ap- 
proach less  nearly  in  resemblance,  so  far  as  the  editor  has 
had  an  opportunity  of  examining  them,  to  the  natural  teeth, 
than  do  those  of  either  England  or  America,  consequently 
they  are  not  employed  as  much  at  present  as  formerly. 

Teeth  constructed  from  the  ivory  of  the  tusk  either  of 
the  hippopotamus  or  elephant,  are,  at  present,  but  little 
used,  and  it  is  a  matter  of  astonishment  that  they  should 
ever  have  been  employed,  to  the  extent  they  once  were, 
for  certainly  they  are  more  objectionable  than  any  other 
description  of  artificial  teeth  ever  worn,  except  those 
made  from  common  bone.  In  the  first  place,  they  read- 
ily absorb  the  fluids  of  the  mouth,  and  in  consequence, 
in  a  very  short  time,  exhale  an  exceedingly  fetid  odour, 
contaminating  the  breath,  and  rendering  the  air  expired 
not  only  offensive  to  those  who  wear  them,  but  also  to 
others.     In  the  second  place,  they  are  less  durable  than 


ARTIFICIAL    TEETH.  361 

other  kinds  of  artificial  teeth,  being  in  the  majority  of 
cases,  soon  decomposed  by  the  fluids  of  the  mouth,  which 
they  vitiate  and  render  unfit  for  the  purposes  for  which 
they  are  designed.  In  the  third  and  last  place,  they  bear 
but  a  very  slight  resemblance  to  the  natural  teeth,  assum- 
ing in  a  short  time  a  blue  or  yellowish  appearance,  and 
eventually  they  become  almost  black. 

But  notwithstanding  the  foregoing  objections,  these 
were  for  many  centuries  almost  the  only  kind  of  artificial 
teeth  used.  In  fact,  twenty-five  years  ago,  they  were 
more  frequently  inserted  than  any  other,  and  there  are 
some  dentists,  even  at  present,  who  use  them. 

Of  the  two  descriptions  of  ivory,  that  of  the  teeth  of  the 
hippopotamus  is  preferable,  and  in  the  construction  of 
artificial  teeth  from  this,  the  enamel,  after  filing  off  the 
outer  rough  surface,  is,  when  practicable,  usually  left,  and 
the  teeth  cut  out  in  such  a  way  as  that  it  shall  cover  their 
front  or  labial  surfaces. 

But,  for  a  number  of  years,  previously  to  the  intro- 
duction of  porcelain  teeth  in  general  use,  the  crowns  of 
human  teeth,  were  much  employed,  and  next  to  these, 
they  are  altogether  and  by  far  preferable,  to  any  other,  as 
artificial  substitutes  for  the  living  organs.  When  prop- 
erly and  accurately  applied,  their  detection  is  rendered 
almost  impossible.  They  are,  however,  liable  to  decay, 
and  a  portion  of  their  bony  structure  being  necessarily 
exposed  to  the  action  of  the  fluids  of  the  mouth,  they 
generally,  after  one  or  two  years,  assume  a  dark  brown 
appearance. 

The  manner  in  which  they  are  usually  procured  is 
from  individuals  who  supply  dissection  rooms  of  medical 
colleges  with  subjects,  and  the  demand  for  them  among 
dentists,  was  so  great,  that  it  was  difficult  to  supply  it, 
although  the  most  exorbitant  price  was  offered  for  them. 


362  ARTIFICIAL    TEETH. 

The  teeth  of  various  animals  have  been  used  for  arti- 
ficial teeth,  but  those  which  have  been  found  to  answer 
the  best  purpose,  are  those  of  neat  cattle.  They  are 
usually  procured  from  slaughter  yards,  and  from  beeves 
of  from  seven  to  nine  years  old,  after  the  pulp  cavities  of 
their  teeth  have  become  nearly  filled  with  bony  matter. 
By  filing  the  lateral  and  posterior  surfaces  of  these  teeth, 
they  may  be  made  to  resemble  very  nearly  in  shape,  the 
human  incisores,  and  when  used  as  substitutes  for  them, 
oftentimes  last  for  several  years.  They  are  only  suitable, 
however,  for  engrafting  to  the  natural  roots,  though  they 
have  often  been  attached  to  plate  and  secured  in  the 
mouth  to  the  adjoining  teeth  by  means  of  clasps.  They 
are  usually  much  whiter  than  human  teeth,  and  have 
apparently  a  smoother  and  more  glossy  surface,  which 
renders  their  detection,  when  used  as  substitutes  for 
these,  almost  certain,  even  by  the  most  casual  observer. 
They  are,  however,  preferable  to  artificial  teeth  made  of 
ivory,  though  by  no  means  equal  to  human  teeth,  and 
since  the  manufacture  of  the  porcelain  teeth  has  been 
brought  to  its  present  comparative  perfection,  they  are 
seldom,  if  at  all  used. 

It  will  be  perceived  from  the  forgoing  remarks  con- 
cerning the  relative  merits  of  the  various  kinds  of  arti- 
ficial teeth,  that  the  porcelain  is  preferable  to  any  which 
have  ever  been  employed.  Having  said  thus  much  upon 
this  branch  of  the  subject,  it  will  be  proper  to  offer  a  few- 
observations  on  the  different  methods  of  applying  dental 
substitutes. 

In  the  insertion  of  artificial  teeth,  it  frequently  becomes 
necessary  to  adopt  different  methods,  in  different  cases,  in 
order  to  meet  the  peculiarities  of  each.  A  method  which 
is  applicable,  and  would  be  most  proper  in  one,  often- 
times is  not  in  another.     But  different  methods  have  been 


ARTIFICIAL    TEETH.  363 

adopted  in  the  same  description  of  cases,  and  where  one 
is  far  preferable  to  any  other.  The  advantages  and  dis- 
advantages of  each  will  be  noticed  in  the  proper  place. 

The  pivoting  method  of  inserting  artificial  teeth,  under 
certain  circumstances,  is  the  best  that  has  ever  been 
adopted,  and  under  all  others,  is  one  of  the  worst. 
It  consists  in  placing  an  artificial  crown  upon  a  natural 
root,  made  fast  by  means  of  a  pivot  or  tenon  fixed  to  the 
former  and  introduced  into  the  latter;  which,  when  it  is 
in  a  healthy  living  condition,  will  oftentimes  remain  firmly 
and  securely  in  its  place,  from  five  to  twenty  years.  But 
from  the  simplicity  of  the  operation,  and  the  ease  with 
which  it  can  be  performed,  it  has  been  greatly  abused, 
having  been  practiced  under  all  circumstances;  and  hence, 
the  worst  and  most  lamentable  consequences  have  fre- 
quently resulted  from  it.  Not  only  should  the  root  be 
possessed  of  vitality  and  free  from  disease,  but  the  parts 
also  which  surround  it,  should  be  in  a  healthy  condition. 
Under  any  other  circumstances,  the  application  of  an 
artificial  tooth  upon  this  principle,  is  not  only  unscientific 
and  improper,  but  is  always,  to  a  greater  or  less  extent, 
productive  of  bad  effects.  There  are  some  cases,  it  is 
true,  where  these,  to  some  extent,  may  be  counteracted, 
and  where,  from  some  very  peculiar  necessity,  a  dentist 
may  be  justifiable  in  inserting  an  artificial  crown  upon  the 
root  of  a  tooth  partially  deprived  of  its  vitality,  provided 
the  contiguous  parts  are  in  a  healthy  state.  But  under 
no  circumstances,  when  these  are  diseased,  should  the 
operation  be  performed. 

Thus,  it  will  be  perceived,  that  the  pivoting  method  of 
inserting  artificial  teeth  is  applicable  only  in  the  fewest 
number  of  cases  which  require  such  substitutes.  JYor  is 
it  applicable  under  any  circumstance  for  the  replacement 
of  the  molar  or  bicuspid  teeth,  and  very  seldom  for  that 


364  ARTIFICIAL    TEETH. 

of  the  inferior  incisores  and  cuspidati.  As  a  general 
rule,  the  roots  of  the  superior  incisores  and  cuspidati  are 
the  only  ones  capable  of  affording  a  firm  and  secure  sup- 
port to  artificial  teeth. 

The  next  method,  which  the  editor  proposes  to  notice, 
consists  in  the  application  of  artificial  teeth  on  plates  se- 
cured in  the  mouth,  to  one  or  more  of  the  remaining  teeth, 
by  means  of  clasps.  This  method  is  applicable  to  a  much 
greater  variety  of  cases,  and  in  the  replacement  of  the 
bicuspides,  the  first  and  even  second  molares,  as  well  as 
the  incisores  and  cuspidati,  when  there  are  not  healthy 
sound  roots  to  engraft  these  last  to,  if  the  second  or  even 
third  molares  are  free  from  disease,  and  firmly  articulated, 
it  is  the  best  and  most  proper  method  that  can  be  adopted. 
It  has  this  advantage  too,  over  all  others,  in  supplying  the 
loss  of  part  of  the  teeth  in  either  jaw;  the  teeth  may  be 
removed  by  the  patient  and  cleansed,  as  often  as  necessary, 
and  replaced  with  perfect  ease  and  without  the  slightest 
difficulty.  This  should  always  be  done  two  or  three  times 
every  day,  and  the  teeth  left  out  every  night,  to  prevent 
the  secretions  of  the  mouth  from  remaining  between  the 
plate  and  the  parts  on  which  it  rests  until  they  become 
vitiated,  and  from  between  the  clasps  and  the  teeth  round 
which  they  pass,  until  they  become  acidulated  and  cause 
the  decay  of  the  latter,  which  they  will  do,  if  this  pre- 
caution be  neglected. 

Artificial  teeth  applied  upon  this  principle,  if  done  cor- 
rectly, may  be  worn  as  long  as  the  teeth  lasts,  to  which 
they  are  attached,  and  they  are  useful  in  the  division 
and  mastication  of  food,  in  proportion  to  the  number  in 
immediate  contact  with  each  other.  But  this  description 
of  dental  mechanism,  to  subserve  the  purposes  just  men- 
tioned, as  well  as  all  others  for  which  such  apparatus  is 
designed,  and  can  be  made  capable  of  doing,  should  be 


ARTIFICIAL    TEETH.  365 

neat  in  its  execution,  perfect  in  its  adaptation  to  the  sub- 
jacent parts  and  the  teeth  to  which  it  is  attached,  and 
be  sufficiently  strong  to  prevent  the  liability  of  injury 
from  the  force  to  be  exerted  upon  it  by  the  antagonizing 
teeth.  The  plate  should  be  three-fourths  of  an  inch  in 
width,  and  sufficiently  thick  to  give  to  it  the  necessary 
strength;  the  clasps  should  be  as  wide  as  the  length  of 
the  teeth  to  which  they  are  applied  will  admit  of  their 
being  made,  and  about  one-third  or  half  thicker  than  the 
plate.  They  should  both  be  made  of  gold,  the  former  of 
from  twenty  to  twenty-two  carots  fine,  and  the  latter  of 
from  eighteen  to  nineteen.  Gold  less  pure  than  the 
above-mentioned,  should  never  be  used  for  any  purposes 
in  the  mouth,  as  it  is  liable  to  oxydize  and  turn  dark. 
Silver  is  often  used  by  a  certain  class  of  practitioners,  but 
it  is  objectionable  for  the  reason  just  stated. 

The  application  of  artificial  teeth  with  spiral  springs,  is 
never  called  for,  except,  for  supplying  the  loss  of  all,  or 
the  greater  part  of  the  teeth  in  both  jaws,  and  when  no 
other  method  for  their  retention  in  the  mouth  can  be 
adopted.  The  springs  being  attached  on  each  side  to 
each  piece,  work  with  the  jaws  and  hold  both,  when  of 
sufficient  strength  and  fixed  in  the  proper  manner  and  at 
the  right  points,  firmly  and  securely  in  their  place. 

The  lower  plate  should  be  fully  double  the  thickness 
of  the  upper,  and  both  should  be  accurately  adapted  to 
all  the  inequalities  of  the  parts  on  which  they  are  to  rest, 
so  as  not  to  be  productive  of  the  least  irritation.  The 
teeth  should  be  so  antagonized  that  all  shall  come  to- 
gether, when  the  mouth  is  closed,  at  the  same  instant. 

The  difficulty  which  so  frequently  attends  the  insertion 

of   double   sets  of   teeth,  or  teeth    applied    with    spiral 

springs,  results  from  the   thinness  and   want  of  correct 

adaptation  of  the  plates,   and   the  improper  manner  in 

17 


366  ARTIFICIAL    TEETH. 

which  the  teeth  are  antagonized.  Much  judgment  and 
mechanical  skill  is  required  to  design  and  construct  in  a 
proper  manner,  a  double  set  of  artificial  teeth,  but  when 
put  up  in  this  manner,  they  may  be  worn  with  ease,  and 
in  most  instances,  will  subserve  to  a  considerable  extent, 
the  purposes  of  the  natural  teeth. 

But,  it  is  not  always  necessary  in  the  application  of  a 
double  set  of  artificial  teeth  to  have  recourse  to  spiral 
springs  for  their  retention  in  the  mouth.  Under  favour- 
able circumstances,  they  may  be  confined  in  the  mouth 
by  the  pressure  of  the  atmosphere  and  capillary  attrac- 
tion, and  when  the  springs  can  be  dispensed  with,  it  is 
always  better  that  they  should  be.  The  editor  has  suc- 
ceeded, in  applying  them  without  springs,  during  the  last 
two  or  three  years,  in  a  number  of  cases.  When  they 
can  be  made  to  adhere  sufficiently  tight,  without  springs, 
they  are  worn  with  much  more  comfort  and  satisfaction 
by  the  patient,  and  the  want  of  success  which  has  so  fre- 
quently resulted  from  attempts  to  apply  them  upon  this 
principle,  has  been  owing  to  the  wrant  of  perfect  adap- 
tation of  the  plates  to  the  parts  which  they  cover. 
This  is  indispensable,  and  in  order  to  which  the  wax 
impressions  of  the  alveolar  ridges  must  be  perfectly  true 
and  correct. 

It  is  much  easier  to  apply  a  dental  substitute  to  the 
upper  than  to  the  lower  jaw  upon  this  principle,  as  the 
upper  usually  presents  a  much  smoother  and  more  prom- 
inent ridge.  It  is  also  much  easier  to  obtain  a  correct 
impression  of  the  upper  than  of  the  lower  jaw,  and  be- 
sides, a  wider  plate,  for  the  atmosphere  to  act  upon,  can 
be  employed,  which  is  a  matter  of  no  small  momenf  in 
applying  teeth  upon  this  principle — yet  it  is  not  neces- 
sary to  have  the  plate  in  any  case  more  than  an  inch  and 
an  eighth  or  an  inch  and  a  quarter  in  width,  for  in  pro- 


ARTIFICIAL    TEETH.  367 

portion  as  it  is  wider  than  this,  the  greater  will  be  the 
difficulty  of  obtaining  a  perfect  fit.  A  plate  of  the  width 
just  mentioned  presents  a  sufficient  amount  of  surface  for 
the  atmosphere  to  act  upon,  and  if  one  wider  than  this 
be  employed,  there  will,  in  nine  cases  out  of  ten,  be  some 
places  on  the  back  part  of  the  ridge  or  palatine  arch  to 
which  it  will  not  be  closely  fitted,  and  where  the  air  will 
be  admitted  and  weaken  the  attachment  of  the  whole. 
For  a  long  time,  the  editor  was  unable  to  discover  the 
cause  of  the  difficulty  he  sometimes  met  with  in  the  ap- 
plication of  teeth  upon  the  suction  or  atmospheric  pres- 
sure principle,  and  it  was  only  by  accident  that  he  at  last 
did  do  it.  Since  which  time  he  has  employed  narrower 
plates,  and  his  success  has  been  more  uniform  and  perfect. 

As  the  lower  plate  can  never  be  very  wide,  in  conse- 
quence of  the  narrowness  of  the  jnferior  alveolar  ridge,  it 
should  be  extended,  when  it  is  designed  to  apply  one 
upon  this  principle,  as  far  back,  on  each  side,  as  possible. 
They  should  be  made  to  reach  up,  a  short  distance,  on  the 
coronoid  processes.  It  was  for  a  long  time  thought  im- 
possible, to  apply  a  lower  plate  upon  this  principle,  but 
the  editor  has  demonstrated  its  practicability  in  a  number 
of  cases,  and  now  he  adopts  in  all,  where  the  circum- 
stances are  at  all  favourable,  and  he  has  succeeded  in 
some,  where,  from  the  great  irritability  of  the  integu- 
ments covering  the  alveolar  ridge,  the  individuals  were 
unable  to  bear  the  pressure  of  spiral  springs.  But  for  a 
fuller  exposition  of  the  merits  of  this  principle,  in  the 
application  of  artificial  teeth,  the  reader  is  referred  to  his 
Principles  and  Practice  of  Dental  Surgery.  He  would, 
however,  remark,  before  he  dismisses  this  part  of  the 
subject,  that  it  is  seldom  applicable  except  for  a  full 
upper  or  under  set. 

The  next  method  which  he  will  notice,  is  one  which 


368  ARTIFICIAL    TEETH 

was  much  in  vogue  during  the  period  of  the  professional 
career  of  the  author,  and  although  it  is  now  never  adopted 
by  scientific  practitioners,  it  may  nevertheless  be  proper 
to  notice  it.  It  consists  in  fastening  artificial  teeth  in  the 
mouth  by  ligatures,  of  silk  or  sea  grass,  or  with  gold  or 
silver  wire  to  the  adjoining  natural  teeth.  This  affords 
not  only  a  weak  and  insecure  support,  but  it  is  productive 
of  injury  to  the  teeth  to  which  the  ligatures  are  attached. 
It  often  pulls  them  from  their  sockets,  or  rather  by  the 
continual  pressure  which  they  exert  upon  the  teeth,  they 
cause  the  destruction  of  the  sockets  and  a  gradual  loosen- 
ing and  ultimate  loss  of  the  teeth.  But  this  is  not  the 
only  effect  which  results  from  fastening  teeth  in  the  mouth 
by  this  means.  They  afford  a  lodgement  for  extraneous 
matter  around  the  teeth  to  which  they  are  attached, 
which,  by  being  retained  there,  soon  cause  them  to  decay. 
Teeth  too,  inserted  in  this  way,  not  being  easily  removed 
by  the  patient,  are  often  retained  in  the  mouth  for  weeks 
and  months,  without  being  taken  out  and  cleansed,  im- 
parting to  the  breath,  the  most  disagreeable  fetor,  and  so 
vitiate  the  fluids  of  the  mouth  as  to  render  them  unfit  to 
be  taken  into  the  stomach.  Fortunately,  however,  this 
method  of  inserting  artificial  teeth,  is  seldom  resorted  to 
at  the  present  day. 

That  barbarous  practice  of  transplanting  a  tooth  from 
the  mouth  of  one  person  into  the  socket  of  that  of 
another,  as  practiced  by  that  celebrated  French  Surgeon 
Ambrose  Pare  and  recommended  by  John  Hunter,  is 
very  justly  condemned  by  the  author.  It  rarely  suc- 
ceeded even  under  the  most  favourable  circumstances, 
and  was  oftentimes  instrumental  in  communicating  to  the 
patient  disease,  which  in  some  instances  proved  fatal. 
A  case  of  this  sort  given  by  Dr.  Watson,  is  contained  in 
"The  Medical  Transactions  of  the  College  of  Physicians" 


ARTIFICIAL    TEETH.  369 

and  copied  by  the  editor  in  his  Principles  and  Practice  oi* 
Dental  Surgery.  But  it  is  unnecessary  to  say  more  con- 
cerning this  method  of  inserting  artificial  teeth,  opposed 
as  it  is,  both  to  the  laws  of  the  animal  economy  and  to 
common  sense.     Happily,  it  is  now  never  practiced. 

In  conclusion,  it  may  be  proper  to  say  a  few  words 
concerning  the  condition  of  the  mouth  at  the  time  of  the 
application  of  artificial  teeth,  and  especially  as  this  is  a 
matter  which  has  been  too  little  regarded  by  the  majority 
of  dental  practitioners.  Hence,  in  many  instances,  the 
bad  effects  which  so  frequently  result  from  their  insertion. 

Every  part  of  the  njputh  should  be  in  a  perfectly 
healthy  condition  at  the  time  of  their  application,  to 
ensure  the  advantages  capable  of  being  derived  from 
them.  If  the  gums  are  swollen  or  inflamed,  or  there  be 
dead,  loose  or  decayed  teeth,  or  tartar,  or  any  other  ex- 
traneous matter  on  the  remaining  organs  in  the  mouth, 
such  preparatory  treatment  should  be  first  instituted  as  may 
be  necessary  to  their  restoration,  else,  the  morbid  action 
already  existing  in  the  parts,  will  be  aggravated  by  the 
presence  of  any  substitute  for  teeth,  which  have  been  lost, 
that  can  be  applied,  however  perfect,  may  be  its  con- 
struction. For  the  completion  of  the  changes  in  the 
alveolar  ridge,  which  follows  the  loss  of  any  of  the  teeth, 
from  three  to  nine  months  are  oftentimes  required.  If 
artificial  teeth  be  inserted  before  these  have  taken  place, 
the  plate  to  which  they  are  fixed,  will  lose  its  adaptation 
to  the  gums,  press  upon  them  unequally,  and  in  conse- 
quence of  which,  be  a  constant  source  of  irritation. 

To  obviate  the  difficulty  and  inconvenience  which 
some  persons  experience  from  the  loss  of  the  natural 
teeth,  a  temporary  substitute  may  be  applied  and  worn 
when  absolutely  necessary,  until  a  permanent  one  can  be 
inserted.  The  material,  however,  employed  for  this, 
should  be  as  pure  and  incorruptible  as  that  for  the  other. 


CHAPTER    SECOND. 

OF   THE    MANNER    OF   INSERTING   A    PIVOT   TOOTH. 

As  it  regards  the  mere  manipulations,  the  insertion  of 
a  pivot  tooth,  ordinarily,  is  one  erf  the  simplest  and  most 
easily  performed  operations  in  dental  surgery.  But  cases 
are,  nevertheless,  occasionally  met  with,  presenting  diffi- 
culties which  require  all  the  judgment,  tact  and  skill,  of 
the  operator,  to  overcome.  For  example,  when  the  root 
has  an  oblique  position  in  the  jaw,  or  is  situated  behind 
the  circle  of  the  teeth,  so  as  to  render  it  necessary,  in 
order  to  the  proper  position  of  the  artificial  crown  to  be 
placed  upon  it,  to  employ  a  crooked  pivot,  or  a  plate  with 
a  pivot  or  tenon  and  plate  tooth.  In  either  of  the  above 
cases,  much  difficulty  is  oftentimes  experienced  in  the 
proper  adjustment  and  insertion  of  the  artificial  tooth. 
But  the  manner  of  overcoming  the  peculiar  difficulties 
presented  by  each,  will  be  presently  described.  When 
the  root  of  the  tooth  does  not  deviate  from  a  vertical 
direction  in  the  jaw,  requiring  merely  a  straight  pivot, 
the  only  skill  called  for  in  the  insertion  of  the  tooth,  is,  to 
fit  it  accurately  to  the  fang,  except  in  those  cases  where 
the  pivot  hole  in  one  is  not  in  exact  opposition  to  that  in 
the  other,  or  when  one  of  the  adjoining  teeth  impinges 
on  the  vacuity  occasioned  by  the  loss  of  the  one  which  is 
to  be  replaced.  The  first  of  the  last-mentioned  difficul- 
ties can  usually  be  overcome  by  the  selection  of  a  suitable 


MANNER    OF    PREPARING   THE    ROOT.  371 

toothy  and  the  last  may  be  obviated  by  filing  off  a  portion 
of  the  side  of  the  tooth  that  impinges  upon  the  aperture, 
or  even  by  grinding  the  artificial  crown. 

MANNER  OF  PREPARING  THE  ROOT. 

In  the  majority  of  the  cases  in  which  it  is  proper  to 
adopt  the  pivoting  method  for  the  insertion  of  an  artificial 
tooth;  a  portion  of  the  crown  of  the  natural  tooth  that  is 
to  be  replaced^  is  still  remaining;  so  that  the  first  step  to 
be  taken  in  the  operation;  is;  its  removal.  This  is  done 
by  some  practitioners;  at  once;  with  a  pair  of  strong  ex- 
cising forceps;  while  others  prefer  cutting  it  partly  off; 
with  a  file;  and  afterwards  completing  the  operation  with 
that  instrument.  By  the  first  method  the  root  is  often- 
times fractured  and  so  much  injured  as  to  render  it  unfit 
to  sustain  a  tooth;  and  even  when  this  does  not  happen, 
the  concussion  is  frequently  so  great  as  to  induce  violent 
inflammation  in  the  alveolo-dental  membranes;  which  not 
unfrequently  terminates  in  suppuration  and  necrosis  of  the 
socket  of  the  tooth.  By  the  second  method;  such  effects 
are  rarely  produced;  and  on  which  account,  it  is  preferable 
to  the  other. 

The  process  of  filing  should  be  commenced  with  a 
safe-sided  separating  file;  which  should  be  passed  be- 
tween the  tooth  to  be  removed  and  one  of  the  adjoining 
ones;  the  smooth  side  of  the  file  towards  the  latter;  nearly 
up  to  the  apex  of  the  gum;  where  the  upper  edge  of  it 
should  be  turned  to  the  pulp  cavity;  and  the  operation 
continued  until  it  has  nearly  reached  it.  The  other  side 
of  the  tooth  should  next  be  filed  in  the  same  manner,  and 
then  a  deep  horizontal  notch  filed  across  its  front  surface, 
when  it  should  be  suddenly  snapped  off  with  a  pair  of 
excising  forceps.     The  crown  of  the  tooth  should  never; 


372  MANNER   OF    PREPARING    THE    ROOT. 

when  the  nerve  is  alive,  be  entirely  cut  off  with  a  file,  as 
the  pain  which  would  be  produced  by  the  contact  of  the 
instrument  with  the  lining  membrane  and  pulp,  would  be 
too  protracted  to  be  endured  by  the  patient. 

After  the  removal  of  the  crown  of  one  tooth,  if  there 
be  another  to  be  taken  off,  the  operation  for  the  removal 
of  the  second  will  be  greatly  facilitated  by  the  increase  of 
room,  gained;  for  the  movement  of  the  file,  and  besides, 
an  oval  or  half  round  file  may  be  employed  instead  of 
a  flat  one,  which  is  not  so  liable  to  become  choked  up  and 
stick  in  the  tooth. 

Having  proceeded  thus  far  with  the  operation,  the  next 
thing  to  be  done,  is  the  destruction  of  the  nerve.  This 
is  effected  by  most  French,  as  well  as  by  some  English 
and  American  practitioners,  by  passing  a  fine  iron  or 
steel  wire,  heated  until  it  is  white,  suddenly  up  the  canal 
of  the  root.  The  destruction  of  the  nerve  by  this  means, 
is  exceedingly  painful,  several  applications  of  the  heated 
wire  often  being  necessary,  and  besides,  it  is  very  apt  to 
excite  inflammation  in  the  surrounding  parts,  and  in  some 
instances  has  been  known  to  produce  very  alarming  con- 
sequences. But  notwithstanding,  it  is  strongly  recom- 
mended and  advocated  as  preferable  to  any  other  method 
by  many  very  respectable  dentists.  The  editor  has,  in 
many  cases,  tested  the  relative  merits  of  this  with  other 
modes  of  destroying  the  nerve,  and  so  much  more  ob- 
jectionable is  this  than  any  other  which  he  has  ever  tried, 
that  for  nearly  seventeen  years,  he  has  not  resorted  to  it 
in  a  single  instance. 

Since  the  employment  of  arsenic  was  recommended  for 
the  destruction  of  nerves  in  teeth,  this  article  has  been 
much  used  for  this  purpose.  But  it  is  objectionable  for 
the  reason,  that  it  not  only  destroys  the  whole  of  the  lining 
membrane  of  the  tooth,  but  it  also  induces  an  unhealthy 


MANNER    OF    PREPARING    THE    ROOT.  373 

action  in  the  investing  membrane,  which,  generally,  in  the 
course  of  a  few  months,  terminates  in  alveolar  abscess, 
thereby  rendering  the  root  unfit  for  the  support  of  an 
artificial  crown  as  well  as  obnoxious  to  the  surrounding 
living  parts.  It  is  important,  therefore,  that  as  much  of 
the  vitality  of  the  root  as  possible,  should  be  preserved. 

The  best  method  of  destroying  the  nerve,  is,  to  do  it 
with  a  small  iron  or  silver  wire  with  the  point  brought  to 
an  edge  and  left  rough,  or  with  a  small  flat  untempered 
drill  or  broach.  Either  will  answer  equally  well.  The 
manner  of  performing  the  operation,  is  to  introduce  the 
instrument  into  the  canal  of  the  root,  about  half  or 
five-eighths  of  an  inch,  giving  it  at  the  same  time  a  quick 
rotary  motion,  which  will  extirpate  the  nerve  as  far  up  as 
the  drill  or  broach  extends,  leaving  the  remaining  por- 
tion, and  lining  membrane  to  supply  the  inner  walls  of 
the  fang  with  vitality  and  nutriment,  which  they  will  of- 
tentimes do  for  years.  But  before  a  wire  can  be  suc- 
cessfully used,  it  is  necessary  that  the  nerve  cavity  should 
be  completely  exposed,  to  prevent  the  operation  from 
being  too  protracted.  With  the  broach  or  drill,  the 
cavity,  even  though  it  be  covered  with  a  thin  layer  of 
bone,  can  be  readily  and  at  once  reached. 

But  whatever  instrument  the  operator  may  determine 
to  employ,  it  is  necessary  to  use  the  same  precaution 
to  prevent  it  from  being  broken  off  in  the  root,  by  any 
sudden  motion  which  the  patient  may  give  to  his  head. 
This,  however,  in  most  instances,  will  be  prevented  by 
informing  him  beforehand,  that  the  operation  will  be  at- 
tended with  considerable  pain,  but  which,  will  be  of  but 
two  or  three  seconds  duration,  if  he  remain  perfectly 
quiet.     This  is  usually  long  enough  for  its  completion. 

This  part  of  the  operation  having  been  completed,  the 
operator  should  next  proceed  to  file  the  root  off,  with  a 
48 


374  MANNER    OF    PREPARING    THE    ROOT. 

round  or  half  round  file,  up  to  the  gum,  and  a  little  above 
its  free  edge,  so  that  when  the  artificial  tooth  is  fitted  to 
it,  the  point  of  connection  between  the  two,  may  be 
wholly  concealed.  The  common  rat-tail  file  was  formerly 
used  for  this  purpose,  but  files  are  now  made  expressly 
for  the  operation  which  may  be  had  in  most  of  the  larger 
cities. 

In  filing  the  root  above  the  free  edge  of  the  gums,  the 
file,  as  it  is  moved  backward  and  forward,  should  be  held 
firmly  against  it,  and  made  to  act  upon  it,  all  the  way 
across,  to  prevent  wounding  the  latter  structure,  which 
will  be  done,  if  the  instrument  be  used  in  any  other 
manner. 

Having  filed  the  root  in  the  manner  as  just  described, 
it  only  remains  to  enlarge  the  canal  in  it,  as  far  up  as  it  is 
necessary  for  the  pivot  or  tenon  to  extend,  which  may  be 
done  either  with  a  broach  or  a  burr  or  cherry-headed 
drill.  The  enlargement  of  the  canal,  when  a  wood  or  a 
wrood-cased  pivot  is  to  be  employed,  should  extend  about 
three-eighths  of  an  inch  up  into  the  root,  and  should  be 
about  the  sixteenth  or  twentieth  of  an  inch  in  diameter. 
No  advantage  whatever  is  gained  by  making  the  canal 
any  larger,  and  when  it  is  done,  as  it  frequently  is,  the 
wralls  of  the  root  are  weakened,  and  a  much  larger  sur- 
face presented  to  the  action  of  the  secretions  of  the 
mouth, — consequently  its  destruction  is  thereby  greatly 
hastened.  When  a  metallic  pivot  is  to  be  employed,  the 
enlargement  of  the  canal  should  extend  up  about  half  an 
inch. 

When  the  canal  has  been  enlarged  by  caries,  so  as  to 
give  the  root  a  funneled  appearance,  after  the  removal  of 
the  diseased  part,  it  should  be  tightly  filled  with  some 
soft  wood,  and  red  cedar  is  perhaps  as  good  as  any  that 
can  be  employed,  with  a  perforation  through  the  centre, 


MANNER    OF    PREPARING    THE    ROOT.  375 

sufficiently  large  for  the  metallic  pivot.  But  the  better 
practice  in  cases  of  this  sort,  is,  to  introduce  a  hollow 
gold  tube,  with  a  screw  cut  on  so  much  of  the  upper 
extremity  as  will  occupy  the  upper  part  of  the  canal 
which  is  of  uniform  dimensions.  This  done,  the  open- 
ing around  the  lower  part  of  the  tube,  should  be  firmly 
and  compactly  filled  with  gold  foil,  which  will  not  only 
hold  it  securely  in  its  place,  but  will  at  the  same  time 
protect  the  inner  walls  of  the  root  against  the  action  of 
the  secretions  of  the  mouth.  The  opening  in  the  tube, 
which  is  intended  for  the  reception  of  the  pivot,  should 
be  about  the  sixteenth  of  an  inch  in  diameter. 

This  method  of  preparing  a  root  is  more  troublesome, 
but  by  far  preferable  to  any  other,  and  as  it  is  very  sel- 
dom, when  a  root  is  so  much  decayed  as  to  call  for  it, 
that  there  is  sufficient  vitality  in  it  to  prevent  it  from 
being  a  source  of  irritation  to  the  contiguous  parts,  it  is 
not  often  necessary  to  resort  to  it  for  the  purpose  of  ob- 
taining a  hold  for  the  pivot.  After  having  secured  it  in 
the  manner  as  above  described,  so  much  of  it  as  projects 
below  the  root,  together  with  the  filling  around  it,  should 
be  removed  with  a  fine  oval  or  half  round  file. 

The  introduction  of  a  hollow  gold  screw  into  the  canal 
in  any  case,  after  having  sufficiently  enlarged  it,  would 
contribute  greatly  to  the  preservation  of  the  root,  and  if 
dentists  would  provide  themselves  with  hollow  gold  wire 
of  the  proper  size,  and  a  screw  plate  and  taps,  the  ope- 
ration would  not  be  attended  with  much  more  trouble 
than  is  consequent  upon  the  ordinary  method  of  inserting 
a  pivot  tooth. 

The  balance  of  the  operation  consists  in  selecting,  fit- 
ing,  and  attaching  the  artificial  crown  to  the  root,  which 
the  editor  will  now  proceed  to  describe. 


376  OF    THE    MANNER    OF    FITTING 

OF  THE  MANNER  OF  FITTING   AND    ATTACHING  A  TOOTH  TO 

THE   ROOT. 

In  the  selection  of  the  toothy  the  operator  should  be 
careful  to  procure  one  of  the  right  size  and  colour,  so 
that  in  neither,  it  shall  differ  sufficiently  from  the  corres- 
ponding natural  tooth,  to  render  its  detection  easy  by  a 
striking  contrast;  for  in  that  case,  the  effect  that  would 
be  produced  on  the  observer,  would  be  worse  than  that 
caused  by  the  loss  of  the  original  organ.  The  base  too, 
of  the  artificial  tooth,  should  be  large  enough  to  cover  the 
root,  and  the  pivot-hole  in  it  deep,  and  exactly  in  the 
centre,  and  as  large  at  the  bottom  as  it  is  at  the  orifice. 
In  many  of  the  porcelain  teeth,  the  pivot-hole  is  faulty 
in  all  of  these  respects,  and  therefore,  it  is  a  matter  that 
should  never  be  overlooked  by  the  dentist.  If  it  is 
smaller  at  the  bottom  than  at  the  orifice,  the  swelling  of 
the  pivot,  if  a  wood  one  be  employed,  will  force  the 
tooth  off  from  the  pivot,  or  if  it  be  a  little  to  one  side,  or 
have  an  oblique  direction,  as  they  oftentimes  have,  the 
proper  adjustment  of  it  on  the  root,  will  be  attended  with 
great  difficulty. 

It  is  often  necessary  in  fitting  an  artificial  crown  to  the 
root,  to  alter  its  original  shape,  which  is  done  by  means 
of  a  grinding  apparatus.  This  may  consist  of  an  emery 
wheel  or  stone  fixed  on  an  axle,  and  turned  either  with 
the  hand  or  foot.  The  most  convenient  and  portable 
kind  are  turned  by  a  small  crank  with  the  hand  of  the 
operator,  and  the  emery  wheel,  when  properly  prepared, 
is  preferable  to  almost  any  stone  which  can  be  procured. 
It  cuts  more  rapidly,  and  is  less  liable  to  injury  from  use. 

After  the  tooth  has  been  ground  so  as  to  fit  the  root 
accurately,  it  should  be  fixed  to  it  with  a  temporary  pivot, 
and  if  it  deviates  in  the  least  from  the  exact  position  it 


AND    ATTACHING   A    TOOTH    TO    THE    ROOT.         377 

should  occupy  on  the  root,  or  if  the  teeth  with  which  it  is 
to  antagonize,  strike  it  in  closing  the  mouth,  such  altera- 
tion should  be  made  in  the  pivot  or  tooth,  as  the  peculiar 
nature  of  the  case  may  require.  When  the  upper  teeth 
close  over  the  lower,  it  is  often  necessary  to  make  the 
tooth  very  thin  by  grinding  it  away  on  the  inside.  As  a 
general  rule,  the  artificial  tooth  should  not  touch  any  of 
the  teeth  in  the  under  jaw. 

After  having  accurately  fitted  the  tooth  to  the  root,  the 
operator  should  then  proceed  to  arm  it  with  a  pivot. 
Wood  is  most  commonly  employed,  and  in  most  cases  is 
preferable  to  any  metallic  substance,  inasmuch  as  by  the 
swelling  of  it  in  the  root,  it  becomes  very  tight,  and  will 
often  hold  the  tooth  securely  in  its  place  for  many  years. 
The  kind  generally  used,  is  close-grained,  well  seasoned 
young  hickory.  This  is  now  prepared  especially  for  the 
purpose,  by  being  made  of  the  right  size  and  firmly  com- 
pressed, and  may  be  had  at  the  principal  establishments 
in  the  country  for  the  sale  of  porcelain  teeth.  When  the 
piece  is  larger  than  the  hole  in  the  tooth,  one  end  should 
be  reduced  to  the  right  size  and  firmly  forced  up  into  it. 
It  should  then  be  cut  off  about  a  fourth  of  an  inch,  or  a 
little  more,  from  the  tooth,  and  the  projecting  part 
trimmed  down  until  it  will  tightly  fit  the  canal  in  the 
root,  into  which,  after  having  been  wiped  out,  it  should 
be  introduced.  No  more  pressure  will  be  required  for 
this  purpose  than  can  be  exerted  with  the  thumb  and 
forefinger  of  the  hand  of  the  operator.  Some  practition- 
ers are  in  the  habit  of  driving  the  pivot  into  the  root,  by 
striking  on  the  tooth  with  a  hammer,  but  this  is  wholly 
unnecessary,  as  the  moisture  of  the  mouth  will  cause  the 
pivot  to  swell  sufficiently  to  prevent  it  from  loosening  or 
coming  out. 

It  sometimes  happens  that  the  antagonizing  tooth  can- 


378  OF    THE    MANNER    OF    FITTING 

not  be  prevented  from  striking  the  artificial  tooth,  and 
they  occasionally  do  it  in  such  a  way  as  to  act  with  great 
force  against  the  pivot,  causing  it  as  it  becomes  saturated 
with  the  fluids  of  the  mouth,  to  bend,  and  the  tooth  to 
project.  To  prevent  which,  the  editor  some  ten  or 
twelve  years  ago,  adopted  the  plan  of  passing  a  gold 
screw  through  the  wood  previously  to  reducing  it  to  the 
proper  size,  and  he  has  derived  much  benefit  from  it. 
This  description  of  pivot,  especially  in  cases  where  the 
lower  teeth  strike  the  artificial,  is  perhaps  the  best  that 
can  be  employed.  The  simplest  way  of  making  one,  is 
to  drill  a  hole,  about  three-fourths  of  an  inch  long,  of  the 
size  of  a  small  knitting-needle,  lengthwise  into  a  piece  of 
well-seasoned  hickory  of  about  an  eighth  of  an  inch  in 
diameter.  This  done,  a  screw  is  cut  on  a  piece  of  gold 
wire,  large  enough  to  fill  the  hole.  The  wood  around 
the  gold  wire  is  then  reduced  to  the  proper  size,  fixed 
in  the  tooth,  cut  off  a  little  more  than  an  eighth  of  an 
inch  from  it  and  the  projecting  part  introduced  into  the 
canal  in  the  root,  in  the  manner  as  before  described. 

For  a  metallic  pivot,  gold  is  the  proper  metal  to  be  em- 
ployed. It  should  be  fully  eighteen  carots  fine,  and  is 
prepared  for  use  by  being  made  into  wire  of  about  the 
sixteenth  part  of  an  inch  in  diameter.  A  piece  of  about 
five-eighths  or  three-fourths  of  an  inch  is  cut  off,  the 
cavity  in  the  tooth  is  filled  with  pulverized  borax,  (sub 
borate  of  soda)  and  water,  one  end  of  the  wire  inserted 
around  which  several  pieces  of  gold  solder  is  placed,  the 
tooth  is  then  fixed  in  a  piece  of  charcoal,  and  a  flame 
from  a  lamp  thrown  on  it  until  the  solder  fuses  and  runs 
down  into  it  around  the  wire.  By  this  simple  process 
the  wire  is  made  fast  in  the  tooth,  and  after  this  has  been 
done,  it  is  made  sharp  at  the  point  with  a  file,  and  several 
small  beards  cut  on  it,  so  that  when  it  is  introduced  into 


AND    ATTACHING    A    TOOTH    TO    THE    ROOT.       379 

the  canal  in  the  root,  which  should  be  previously  filled 
with  some  soft  wood,  pierced  through  the  centre,  it  will 
not  be  liable  to  loosen  and  come  out.  Artificial  teeth  are 
often  securely  retained  by  this  description  of  pivot  for 
many  years. 

When  an  artificial  tooth  is  engrafted  to  a  root  from 
which  there  is  a  fetid  discharge,  an  outlet  should  be  pro- 
vided for  the  escape  of  the  matter.  This  may  be  done 
by  cutting  a  groove  on  the  side  of  the  pivot  as  recom- 
mended by  Dr.  L.  S.  Parmly,  or  by  the  employment  of 
a  tubed  pivot  with  an  opening  through  the  crown  of  the 
tooth  opposite  to  the  pivot-hole  as  proposed  by  Dr.  E.  H. 
Elliott.  Either  method,  by  giving  egress  to  the  matter, 
will  prevent  its  accumulation  in  the  root,  and  the  conse- 
quent formation  of  an  alveolar  abscess. 

That  it  is  unscientific  to  apply  an  artificial  crown  to  the 
root  of  a  tooth  under  such  circumstances,  every  one  must 
admit,  but  there  are  cases,  in  which,  from  some  peculiar 
necessity,  the  practice  may,  perhaps  be  justifiable,  and  by 
adopting  the  plan  just  described,  the  hurtful  effects  that 
would  otherwise  inevitably  result,  may  be  measurably 
counteracted.  But  even  the  presence  of  a  dead  root  of 
a  tooth,  or  that  of  one  from  which  fetid  matter  is  con- 
stantly being  discharged,  must  of  necessity  be  productive 
of  injury  to  the  patient,  and  therefore,  under  all  ordinary 
circumstances,  a  dentist  would  be  exceedingly  remiss  in 
the  discharge  of  his  duty,  if  he  fails  to  urge  upon  him 
the  importance  of  its  immediate  removal. 


CHAPTER    THIRD. 

OF    THE     MANNER    OF     FITTING     AND     ADAPTING     A     PLATE,     AND 
ATTACHING    CLASPS    AND    ARTIFICIAL    TEETH    TO    IT. 

In  the  construction  of  a  dental  substitute  to  be  held  in 
the  mouth  by  means  of  a  gold  plate  and  clasps,  fixed  to 
some  of  the  remaining  natural  teeth,  it  is  necessary  that 
it  should  be  adapted  with  the  most  perfect  accuracy,  to 
the  parts  on  which  it  is  to  rest,  and  that  it  antagonize 
correctly  with  the  teeth,  with  which  it  should  come  in 
contact  when  the  mouth  is  closed,  or  that  it  does  not 
strike  these  before  the  others  meet,  provided  there  be 
teeth  back  of  it  in  both  jaws.  It  should  be  so  contrived 
too,  as  to  restore  the  symmetry  of  the  face,  which  is 
always  more  or  less  injured  by  the  loss  of  several  teeth. 
The  operation  of  constructing  a  dental  substitute  of  the 
description  now  under  consideration,  may  be  properly 
divided  into  four  parts. 

The  first  consists  in  taking  an  impression  of  the  parts 
on  which  the  substitute  is  to  rest,  and  with  which  it  is  to 
be  connected,  in  wax.  The  second,  in  procuring  from 
the  wax  impression,  first,  a  plaster,  and  second,  a  metallic 
model  and  counter  model.  The  third,  in  swedging  up 
the  plate  and  attaching  clasps  to  it.  The  fourth  and  last, 
in  taking  an  articulating  model,  in  fitting,  antagonizing, 
and  attaching  the  teeth,  and  finishing  the  work. 

In  describing  these  several  parts  of  the  operation,  the 
order  just  mentioned  will  be  followed. 


MANNER    OF    TAKING    A    WAX    IMPRESSION.       381 


OF  THE  MANNER  OF  TAKING  A  WAX  IMPRESSION. 

Although  the  taking  of  an  impression  of  the  mouth,  is 
a  very  simple  operation,  it  is  nevertheless  often  attended 
with  great  difficulty,  for  if  this  be  incorrect,  it  will  be 
impossible  to  make  a  plate  to  fit  the  parts  on  which  it  is 
to  rest  and  the  natural  teeth  to  which  it  is  to  be  attached. 
Different  dentists  employ  different  preparations  of  wax 
for  this  purpose,  but  there  is  nothing  better  than  the 
common  beeswax.  But  whether  this  or  any  other  prep- 
aration be  used,  it  should  be  previously  softened,  until 
it  is  of  about  the  consistence  of  soft  putty,  in  warm 
water.  It  should  then  be  placed  in  a  semi-circular  box 
or  frame,  made  of  tin  or  silver,  large  enough  to  encase 
or  cover  the  whole,  or  so  much  of  the  alveolar  ridge,  as 
an  impression  from  which,  may  be  required,  and  leave  a 
small  space  on  each  side.  The  wax  thus  enclosed, 
should  be  placed  in  the  mouth,  and  pressed  against  the 
jaw  until  a  deep  impression  is  made  in  it  by  the  parts  to 
which  it  is  intended  to  apply  the  artificial  teeth,  and  to 
the  adjoining  natural  teeth  as  far  back  as  it  may  be  neces- 
sary to  extend  the  plate,  and  to  which,  the  clasps  are  to 
be  fixed.  This  done,  the  wax  which  has  escaped  from 
the  frame,  should  be  pressed  against  the  alveolar  ridge,  all 
round,  and  on  each  side,  by  the  forefinger  of  the  hand  of 
the  operator;  and  after  being  well  assured  a  correct 
impression  has  been  made,  the  whole  should  be  carefully 
removed  from  the  mouth.  In  doing  this,  the  greatest 
care  is  necessary  to  prevent  the  wax  above  the  outer 
edges  of  the  frame  from  being  bent  by  the  corners  of 
the  mouth.  This  is  oftentimes  attended  with  great  diffi- 
culty, and  sometimes  it  is  necessary  to  take  several  im- 
pressions before  a  perfect  one  can  be  obtained. 
49 


382         MANNER    OF    OBTAINING    A    PLASTER    AND 

The  wax-holder  or  frame,  should  have  a  handle  at- 
tached to  the  front  part  of  it,  of  about  an  inch  and  a  half 
or  two  inches  in  length.  Every  dentist  should  be  pro- 
vided with  from  ten  to  fifteen  frames  of  this  description, 
varying  both  in  shape  and  size.  Dr.  Elliott  of  Platts- 
burg,  N.  Y.  recommends  that  they  be  "  formed  by  being 
swedged  between  a  model  and  counter  model,  in  the 
same  manner  that  a  gum  plate  is  fitted  to  the  mouth." 
This  description  of  wax-holder,  is  certainly  preferable  to 
those  commonly  used,  and  in  one  instance  the  editor 
found  it  absolutely  necessary  to  have  one  made,  in  order 
to  obtain  a  correct  impression.  But  in  all  cases  where 
the  mouth  is  of  the  ordinary  size,  the  others  will  answer. 


OF  THE  MANNER  OF  OBTAINING  A  PLASTER  AND  A  METALLIC 
MODEL  AND  COUNTER  MODEL. 

Previous  to  filling  the  wax  impression  with  plaster, 
every  part  of  it  should  be  smeared  with  oil.  The  best 
way  of  applying  this,  is,  with  a  small  camel's  hair  pencil. 
If  there  are  any  teeth  in  the  jaw,  a  pin  or  short  piece 
of  small  iron  wire  should  be  stuck  in  the  bottom  of  the 
impression  made  by  each,  for  the  purpose  of  strengthen- 
ing those  which  will  be  formed  on  the  plaster  model,  and 
to  prevent  their  liability  to  break. 

As  it  will  be  necessary  to  raise  the  plaster  above  the 
wax  impression,  a  rim  or  border  of  pasteboard  or  folded 
paper,  an  inch  wide,  may  be  passed  around  it  and  made 
fast  by  pinning.  The  connection  of  this  to  the  wax  im- 
pression should  be  sufficiently  close  to  prevent  the  plaster 
from  escaping. 

The  plaster  should  be  of  the  best  quality.  That  used 
for  making  busts  is  generally  superior  to  any  other  that 
can  be  obtained,  and  when  this  can  be  had,  it  should  be 


A    METALLIC    MODEL    AND    COUNTER    MODEL.       383 

preferred.  It  should  be  prepared  by  stirring  it  in  water 
until  a  batter  is  formed,  which  should  not  be  too  thick  to 
prevent  it  from  descending  readily  into  all  the  depres- 
sions in  the  wax.  The  plaster  being  thus  prepared,  the 
impression  should  be  slowly  filled,  putting  on  a  sufficient 
quantity  of  the  batter,  which  by  this  time  will  have  be- 
come much  thicker,  to  raise  the  model  nearly  to  a  level 
with  the  paper  border. 

From  two  to  four  hours  should  elapse,  after  filling  the 
impression,  for  the  plaster  to  harden,  before  it  is  taken 
from  the  wax,  which,  in  most  instances,  is  easily  done, 
but  when  from  the  number,  great  length,  or  peculiar 
shape  of  the  teeth,  it  cannot  be  easily  separated,  the  wax 
should  be  placed  in  warm  water  and  allowed  to  remain, 
until  it  has  become  a  little  softened,  when  the  plaster 
may  be  readily  removed. 

It  should  now  be  trimmed  in  such  a  manner  that  the 
metallic  model  which  will  be  shaped  exactly  like  it,  may 
be  removed  without  difficulty  from  the  counter  metallic 
model.  This  is  sometimes  neglected,  and  in  consequence 
of  which,  the  two  become  locked  together,  so  that  they 
cannot  be  separated. 

Brass,  zinc,  lead,  and  tin,  are  the  metals  usually  em- 
ployed for  the  metallic  models.  The  last  is  more  easily 
fused  than  either  of  the  others,  and  in  the  majority 
of  cases,  answers  equally  well.  The  plan  which  the  edi- 
tor, in  common  with  many  other  dentists,  adopts,  for  the 
procurement  of  a  metallic  model,  is,  to  fuse  some  four  or 
five  pounds  of  lead  in  a  strong  round  sheet  iron  box  or 
ladle,  about  three  inches  deep,  and  at  the  bottom,  about 
three  inches  in  diameter,  but  a  little  larger  at  the  top;  then 
to  immerse  as  much  of  the  plaster  model  in  it  as  was 
formed  in  the  wax  impression,  and  holding  it  there,  until 
the  metal  chills  around  it.     When  the  lead  gets  cold, 


384    MANNER    OF    FITTING    AND    STAMPING    A    PLATE 

which  process  may  be  hastened  by  pouring  cold  water  on 
it,  the  plaster  may  then  be  broken  to  pieces  and  taken 
out.  The  counter  model  thus  formed  should  be  covered 
with  a  little  whiting  mixed  with  water,  put  on  with  a 
camel's  hair  pencil,  or  smoked  over  a  lamp.  This  done, 
three  or  four  pounds  of  tin  should  be  fused  in  another 
ladle,  and  at  a  temperature  which  will  not  char  or  dis- 
colour white  paper,  poured  in  this  while  still  in  the  ladle 
first  employed.  When  cold  both  may  be  taken  out  and 
separated  from  each  other. 

This  is  the  simplest  way  in  which  a  metallic  model  and 
counter  model  can  be  obtained.  It  is  also  the  most  per- 
fect. Some  dentists,  however,  are  in  the  habit  of  making 
the  model  first,  which  is  done  by  making  an  impression 
with  the  plaster  cast  in  sand,  such  as  is  used  at  brass  and 
iron  foundries;  then  fusing  the  tin  or  brass,  or  zinc  and 
lead,  whichever  may  be  employed,  and  pouring  it  into  the 
impression  thus  made,  and  afterwards  obtaining  a  counter 
model  from  the  model  thus  procured.  The  first  method 
is  the  best,  for  the  reason  that  it  ensures  a  much  smoother 
and  more  perfect  model.  But  it  is  necessary  when  taken 
in  that  way  to  have  a  duplicate  plaster  model,  which, 
however,  may  generally  be  obtained  from  the  wax  im- 
pression in  which  the  first  was  formed.  Should  this, 
however,  be  injured,  in  the  removal  of  the  first  plaster 
model,  it  will  be  necessary  to  take  a  second  wax  impres- 
sion. 


OF   THE   MANNER   OF    FITTING   AND   STAMPING    A    PLATE   AND 
ATTACHING  CLASPS  TO  IT. 

The  plate  in  the  first  place  should  be  got  out  to  the 
proper  size  and  shape,  from  a  sheet  lead  pattern,  pre- 
viouslv  obtained  from  the  model,  which  should  be  from 


AND    ATTACHING    CLASPS    TO    IT.  385 

three-fourths  of  an  inch,  to  an  inch  in  width.  And  it 
may  be  well  to  remark  here,  that  the  plate  should  be 
thick  enough  to  prevent  it  from  being  easily  bent  or 
broken,  and  the  best  way  to  secure  a  uniform  thickness, 
is  to  have  it  always  got  out  by  a  gage,  such  as  is  used  by 
watch  casers,  which  are  numbered.  The  plate  usually 
used  by  the  editor  for  the  upper  jaw,  and  he  does  not 
think  it  at  all  too  thick,  fits  tightly  in  number  twenty-six, 
and  that  which  he  employ  for  clasps,  in  twenty-four  or 
five. 

After  having  cut  out  a  plate  of  the  right  size  and 
shape,  and  fitted  it  as  closely  to  the  model  as  possible 
with  a  pair  of  plate  forceps  and  a  small  round-faced 
hammer,  it  should  be  annealed,  by  heating  it  on  a  piece 
of  charcoal  with  a  lamp  and  blow-pipe.  This  done,  it 
should  be  swedged  up  between  the  model  and  counter 
model,  with  a  heavy  hammer,  until  it  fits  with  the  most 
perfect  accuracy,  every  part  which  it  covers.  And 
during  the  process,  it  is  often  necessary  to  take  it  out 
once  or  twice,  and  re-anneal  it. 

The  posterior  extremities  of  the  plate  should  fit  up 
closely  to  the  teeth  to  which  the  clasps  are  to  be  applied, 
and  if  there  be  any  anterior  to  these,  a  space  of  an  eighth 
or  twelfth  of  an  inch  between  it  and  them  should  be 
left  uncovered,  to  prevent  irritating  the  margins  and 
apices  of  the  gums,  which  is  almost  certain  to  result 
from  contact  with  the  plate. 

The  plate  should  now  be  placed  on  the  plaster  model, 
and  clasps  accurately  fitted  to  the  teeth,  one  on  each  side, 
when  practicable,  if  two  be  employed.  But  when  the 
teeth  on  one  side  have  all  been  lost,  and  there  be  good 
teeth  to  clasp  to  on  the  other,  two  may  be  used  on  that 
side,  and  which,  when  properly  applied,  may  be  made  to 
support  a  plate  with  artificial  substitutes  for  all  the  other 


386    MANNER    OF    FITTING   AND    STAMPING   A   PLATE. 

teeth.  In  fact,  one  has  oftentimes  been  made  to  do  this 
for  years,  without  having  been  attended  with  any  un- 
pleasant effects  whatever,  and  in  the  insertion  of  a  single 
tooth  in  the  front  part,  or  two  or  even  three  on  the  side, 
of  the  mouth,  it  is  seldom  necessary  to  apply  more  than 
one  clasp.  But  in  this  case,  the  clasp  should  be  fixed  to 
a  bicuspis  or  first  or  second  molaris. 

After  the  clasps  have  been  fitted  to  the  teeth,  they 
should  be  connected  to  the  plate,  while  on  the  model,  by 
means  of  two  pieces  of  wax,  softened  until  they  are  about 
the  consistence  of  putty.  The  plate  and  clasps  should 
now  be  taken  off,  without  altering  in  the  least  their  rela- 
tive position,  and  placed  on  a  piece  of  paper  with  the 
concave  side  of  the  plate  upwards,  then  plaster  of  Paris, 
prepared  in  the  manner  as  before  described,  poured  over 
it  and  the  clasps.  As  soon  as  this  becomes  hard,  the 
piece  may  be  lifted  from  the  paper,  and  the  wTax  taken 
off,  when,  if  there  be  any  apertures  between  the  clasps 
and  plates,  they  should  be  filled  either  with  gold  foil  or 
small  pieces  of  plate.  Finely  ground  borax  (sub  borate 
of  soda)  mixed  with  water,  until  it  is  of  the  consistence 
of  cream,  should  now  be  applied  with  a  camel's  hair 
pencil,  to  the  parts  to  be  united,  and  after  which,  several 
small  pieces  of  fine  gold  solder.  It  should  next  be 
placed  on  a  piece  of  charcoal  and  the  flame  of  a  spirit 
or  oil  lamp  be  thrown  upon  it  with  a  blow-pipe,  until  the 
solder  fuses  and  unites  the  clasps  to  the  plate. 

It  is  much  better  to  solder  the  clasps  to  the  plate  in 
this  manner  than  to  do  it  on  the  plaster  model,  as  that 
will  be  afterwards  needed,  and  is  liable  to  be  injured  by 
the  intense  heat  necessary  to  be  applied  to  fuse  the  solder. 

The  clasps  having  been  soldered  to  the  plate,  the  piece 
should  be  placed  in  diluted  sulphuric  acid,  and  allowed 
to  remain  about  twenty  or  thirty  minutes  for  the  purpose 


ATTACHING    THE    TEETH   TO    THE    PLATE.        387 

of  decomposing  the  borax  which  remains  on  the  part  of 
the  plate  and  clasps  to  which  it  was  applied,  and  by  the 
action  of  the  heat  has  become  almost  as  hard  as  glass. 
This  done,  the  work  should  be  cleansed  for  the  reception 
of  the  teeth. 

When  it  is  necessary  to  supply  the  loss  of  several 
teeth,  in  different  parts  of  the  mouth,  but  in  the  same 
jaw,  by  means  of  one  plate,  the  teeth  on  the  plaster  model 
should  be  cut  off,  before  the  metallic  model  is  made,  and 
a  plate  covering  the  whole  of  the  alveolar  ridge,  or  ex- 
tending back  as  far  as  the  teeth  to  which  it  is  to  be 
clasped,  should  be  sweclged  up,  and  the  places  of  the 
natural  teeth  afterwards  filed  out.  A  plate  can  be  made 
to  fit  more  perfectly  in  this  way  than  by  cutting  out  the 
places  for  these  teeth  before  it  is  stamped  up,  as  in  this 
process,  it  is  liable  to  draw  off  from  them. 


OF  THE  MANNER  OF  FITTING  AND  ANTAGONIZING  THE  TEETH, 
ATTACHING  THEM  TO  THE  PLATE,  AND  FINISHING  THE 
WORK. 

After  having  selected  such  teeth  as  correspond  in  class 
with  those  which  have  been  lost,  and  in  colour  with  the 
adjoining  natural  teeth,  the  operator  should  proceed  to 
fit  them  to  the  plate,  and  in  doing  this,  it  will  be  neces- 
sary, in  the  majority  of  cases,  to  grind  them  more  or  less 
on  the  base.  No  apertures  should  be  left  between  the 
teeth  and  plate,  as  they  would  become  receptacles  of  ex- 
traneous matter,  exceedingly  difficult  to  clean,  and  to 
prevent  which,  great  care  is  requisite,  especially  in  those 
cases  where  the  alveolar  ridge  is  very  rough  and  uneven. 

As  the  teeth  are  selected  and  arranged  on  the  plate, 
they  should  be  held  in  their  place  by  a  rim  of  softened 
wax  behind  them,  such  as  recommended  to  be  used  in 


388   ATTACHING  THE  TEETH  TO  THE  PLATE 

taking  impressions,  and  it  will  be  proper  to  remark  in 
this  place,  that  when  the  alveolar  ridge  is  exposed  in 
laughing,  the  plate  should  not  cover  the  anterior  part  of 
it.  The  anterior  portion  of  the  base  of  the  artificial 
teeth,  in  this  case,  should  cover  the  edge  of  the  plate  and 
be  accurately  fitted  to  the  gums,  but  when  the  alveolar 
ridge  is  not  exposed  in  laughing,  a  much  larger  portion 
of  it  may  be  covered  by  the  plate. 

It  sometimes  happens  that  the  whole  of  the  alveolar 
ridge  has  been  wasted  by  disease  in  the  gums  and  alve- 
olo-dental  membranes,  or  destroyed  by  necrosis  and  ex- 
foliation.    To  supply  this  loss  of  substance,  it  becomes 
necessary  to  make  a  raised  or  box  plate,  or  to  employ 
what  is  commonly  termed  gum  teeth,  and  in  some  cases 
both  can  be  advantageously  applied.     The  most  conve- 
nient and  best  manner  of  making  a  box  plate,  is,  to  fit  up 
a  plate  first  in  the  usual  manner,  then  to  put  on  a  paste, 
or  thick  batter,  made  of  plaster  of  Paris,  which  should 
be  raised  to  the  proper  height  and  afterwards  trimmed  to 
the  proper  shape,  leaving  about  an  eighth  of  an  inch  of 
the   plate  on  each  side  exposed — with  this  a  metallic 
model  and  counter  model  should  be  obtained  in  the  man- 
ner as  before  described,  and  between  which  another  plate 
should  be  swedged.     This  last  is  to  be  filed  until  it  fits 
the  first,  and  then  soldered  to  it.     But  previously  to  this, 
a  small  hole  should  be  pierced  for  the  escape  of  the  air, 
which  becomes  expanded  by  the  heat  employed  in  solder- 
ing, and  after  the  teeth  have  been  soldered  on,  it  should 
be  closed   by  the  introduction  of  a   small  gold  screw, 
which,  in  finishing  the  piece,  should  be  cut  off  close  to 
the  plate.  .    . 

In  arranging  the  teeth  on  the  plate,  it  is  better,  in 
most  cases,  to  have  an  antagonizing  model,  which  may  be 
obtained  in  the  following  manner.     Place  a  rim  of  soft- 


AND    FINISHING    THE    WORK.  389 

€ned  wax,  three-fourths  of  an  inch  in  width,  on  the 
convex  side  of  the  plate,  after  it  has  been  fitted  and  the 
clasps  attached  to  it;  let  the  plate  now  be  put  in  the 
mouth,  and  the  patient  be  directed  to  close  his  jaw  nat- 
urally, until  his  back  teeth  come  together,  or  if  he  has 
none  which  antagonize  with  each  other,  pass  a  wedge  of 
wood,  of  a  width  equal  to  the  length  required  for  the 
artificial  teeth,  through  the  wax,  with  one  edge  in  con- 
tact with  the  plate,  and  then  let  him  be  directed  to  close 
his  mouth  until  the  teeth  which  are  to  antagonize  with 
the  artificial  ones,  come  in  contact  with  the  other.  The 
wax  should  now,  while  the  jaws  are  thus  closed,  be 
pressed  around  the  natural  teeth;  this  done,  the  mouth 
may  be  opened,  and  the  plate  with  the  wax  removed, 
using  the  precaution  at  the  time,  not  to  bend  or  alter  the 
shape  of  the  latter. 

Let  the  concave  side  of  the  plate,  and  the  wax  which 
has  received  the  impression  of  the  teeth,  be  now  lightly 
smeared  with  olive  oil,  in  the  manner  as  previously  de- 
scribed; next  place  it  on  a  piece  of  paper,  some  six  or 
eight  inches  square,  and  fill  one  side  with  a  thick  batter 
made  of  plaster,  letting  it  extend  back  of  the  wax  impres- 
sion, or  plate,  as  the  case  may  be,  on  the  paper,  about  two 
inches,  adding  to  it  from  time  to  time,  as  it  becomes 
stiffer,  until  it  is  about  an  inch  in  thickness.  As  soon  as 
the  plaster  has  solidified  sufficiently,  the  edges  and  sides 
may  be  trimmed  with  a  sharp  knife,  and  about  half  an  inch 
of  the  under  surface  extending  behind  the  wax  and  plate 
cut  away,  and  two  or  three  deep  grooves  formed  across 
it,  and  crossing  each  other  at  right  angles.  These  should 
now  be  oiled  and  the  whole  of  the  surface  of  the  plaster 
on  the  same  side,  together  with  the  wax  impression  or 
plate  in  front  of  it,  if  it  were  not  done  at  the  time  the 
oil  was  applied  to  the  side  previously  filled.  This  done, 
50 


390    ATTACHING  THE  TEETH  TO  THE  PLATE 

let  a  batter  of  plaster  be  put  on  this  side  in  the  manner 
as  directed  for  putting  it  on  the  other,  and  when  it  has 
hardened  sufficiently,  it  may  be  trimmed,  and  the  two 

taken  apart  and  the  wax  removed. 

In  a  model  of  this  description,  the  teeth  may  be  ar- 
ranged, fitted  and  so  antagonized  that  all  shall  meet  the 
teeth  in  the  other  jaw  at  the  same  instant.  But  when 
only  one  or  two  teeth  are  to  be  inserted,  it  will  not  be 
necessary  to  incur  the  trouble  consequent  upon  the  pro- 
curement of  such  a  model. 

The  teeth  being  fitted  to  the  plate,  and  antagonized, 
the  next  thing  to  be  done,  is,  to  put  on  gold  backings. 
For  this  purpose  two  platina  rivets  are  fixed  in  the 
palatine  or  lingual  surface  of  each,  about  the  twelfth  of 
an  inch  long.  They  are  fixed  in  the  teeth  while  they  are 
being  manufactured  before  they  are  baked.  The  backings 
are  made  from  a  strip  of  gold  plate,  a  little  thicker  than  that 
to  which  the  teeth  are  applied.  The  manner  of  putting 
a  backing  on  a  tooth,  is  to  punch  a  hole  through  the  strip 
of  gold  plate  near  one  end,  with  a  pair  of  punch  forceps 
made  expressly  for  the  purpose,  to  insert  one  of  the  pla- 
tina rivets  into  it,  and  by  moving  the  other  end  of  the 
plate  two  or  three  times  backwards  and  forwards,  over 
the  other  rivet,  to  mark  its  distance  from  it,  then  to 
punch  another  hole  through  the  plate  at  the  point  thus 
indicated,  immediately  below  the  first;  afterwards  to  en- 
large the  holes  on  the  outer  side  of  the  plate  with  a  sharp 
triangular  pointed  instrument,  called  a  counter  sink,  then 
put  the  plate  on  the  tooth,  file  off  the  protruding  ends  of 
the  platina  pins  nearly  down  to  the  plate,  which  should 
now  be  made  fast  by  riveting.  This  done,  the  plate  should 
be  cut  off  close  up  to  the  tooth,  which  should  now  with 
its  gold  back  be  refitted  to  the  plate  it  is  to  be  attached  to, 
the  rim  of  wax  on  the  inside  behind  it,  still  supporting 


AND    FINISHING    THE    WORK.  391 

and  keeping  it  in  its  proper  place.  The  backing,  how- 
ever, should  be  filed  and  made  to  fit  closely  to  the  plate. 
It  should  also  fit  up  closely  to  the  tooth,  and  have  its 
edges  neatly  bevelled  off.  It  should  cover  the  whole  of 
the  back  of  the  tooth  to  within  about  a  sixteenth  of  an 
inch  of  its  cutting  extremity. 

Some  dentists  are  in  the  habit  of  putting  on  a  raised 
back,  giving  as  a  reason  for  so  doing,  that  it  gives  to  the 
tooth  a  firmer  support,  but  the  editor  has  never  been  able 
to  perceive  that  any  advantage  whatever  was  derived 
from  it.  Others  again,  after  fitting  the  teeth  to  the  plate, 
cover  their  anterior  surfaces  and  cutting  edges  with 
plaster,  and  take  off  the  rim  of  wax  from  behind,  before 
they  put  on  the  backings,  believing  that  they  can  in  this 
way  fit  them  more  closely  to  the  plate.  They  may, 
however,  be  fitted  to  it  as  accurately  in  the  manner  first 
described,  as  by  this  method,  and  in  one-half  the  time. 

When  the  backings  are  all  fitted  to  the  teeth,  the  plate 
with  the  teeth  and  wax  should  be  taken  from  the  model 
and  placed  on  a  large  piece  of  charcoal,  and  then  covered 
with  a  batter  of  plaster.  When  this  becomes  hard,  the 
wax  should  be  removed,  and  if  there  be  any  openings 
between  the  backings  and  the  plate,  they  should  be 
closed  with  small  pieces  of  gold  plate  or  foil.  This  done, 
borax,  prepared  in  the  manner  as  before  described,  should 
be  freely  applied,  where  it  is  intended  the  solder  should 
take  effect,  namely,  at  the  points  of  connection  between 
the  backings  and  the  plate  and  around  each  platina  rivet. 
At  each  of  these  places,  several  small  pieces  of  fine  gold 
solder  should  be  placed,  except  over  the  rivets, — one 
being  sufficient  for  each  of  these. 

The  solder  employed  for  this  purpose,  as  well  as  that 
for  uniting  any  description  of  mechanism  to  be  worn  in 
the  mouth,  should,  if  possible,  be  fine  enough  to  resist 


392   ATTACHING  THE  TEETH  TO  THE  PLATE 

the  action  of  the  secretions  of  this  cavity.  The  following 
recipe,  copied  from  the  editor's  Principles  and  Practice 
of  Dental  Surgery,  will  perhaps  be  found  as  well  adapted 
to  dental  purposes,  as  any  that  can  be  employed.  It 
makes  an  excellent  fine  flowing  solder. 

2  dwt.  22  car.  gold. 
16  grs.  fine  silver. 
12  grs.  roset  copper. 

Previous  to  use,  it  should  be  rolled  out  in  a  thin  strip, 
and  cut  into  very  small  pieces.  It  fuses  more  readily 
and  flows  more  freely  when  the  pieces  are  small. 

The  soldering  on  of  the  teeth,  is  a  nice  and  somewhat 
difficult  part  of  the  operation,  and  although  greatly  facili- 
tated by  a  good  lamp  and  blow-pipe,  a  thorough  know- 
ledge of  it  can  only  be  acquired  by  practice.  The  lamps 
most  frequently  employed,  and  which  answer  very  well, 
are  similar  to  those  used  by  silver  and  goldsmiths,  and 
spirits  of  wine  (alcohol)  is  now  generally  preferred  to 
oil.  It  makes  a  clearer  and  purer  flame,  and  gives  out 
about  the  same  quantity  of  heat.  When  this  is  used,  the 
lamp  should  hold  fully  a  pint,  and  have  a  spout  from 
three  to  four  inches  in  length,  and  three-fourths  of  an 
inch  in  diameter,  which  should  be  filled  with  wick,  to 
prevent  the  flame  from  extending  down  into  the  lamp 
and  causing  an  explosion.  This  has  sometimes  happened, 
when  the  above  precaution  has  been  neglected. 

Hook's  self-acting  blow-pipe  is  thought  much  of 
by  some  practitioners,  and  as  improved  by  Dr.  Jahial 
Parmly  of  New  York,  is  certainly  very  valuable  for  den- 
tal purposes.  Dr.  Elliott  of  Plattsburg,  has  also  added 
to  this  blow-pipe  and  lamp  a  very  important  improve- 
ment, which  consists  in  feeding  the  flame  with  atmos- 


AND    FINISHING    THE    WORK.  393 

pheric  air,  by  means  of  a  bellows  worked  by  the  foot. 
But  Dr.  Somerby's  furnace  and  blow-pipe  is  the  best 
instrument  of  the  kind  which  the  editor  has  ever  em- 
ployed. An  engraving  of  this,  as  well  as  Dr.  Elliott's 
self-acting  blow-pipe,  may  be  seen  in  the  editor's  Princi- 
ples and  Practice  of  Dental  Surgery,  to  which,  for  a 
more  minute  description  of  each,  the  reader  is  referred. 

If  the  common  blow-pipe  be  used,  it  should  be  from 
fifteen  to  eighteen  inches  in  length,  and  have  a  tolerably 
large  orifice,  to  enable  the  operator  to  control  as  much  of 
the  flame  of  the  lamp  as  possible.  The  blow-pipes  ordi- 
narily employed  by  silversmiths  are  too  short.  They 
bring  the  eyes  of  the  operator  so  near  the  flame  of  the 
lamp,  that  they  are  oftentimes  injured  by  the  intensity  of 
the  heat  and  light. 

The  work  being  ready  for  soldering,  the  lamp  should 
be  lit,  and  as  much  of  the  flame  as  possible,  thrown  with 
the  blow-pipe,  on,  first,  the  plaster,  and  kept  there  until 
this  has  attained  a  red  heat,  then  on  the  point  of  connec- 
tion between  the  backing  of  one  of  the  teeth  and  the 
plate,  and  as  soon  as  the  solder  flows  well  here  and 
around  the  two  platina  rivets,  it  should  be  passed  to 
another  and  another,  until  the  whole  process  is  com- 
pleted. After  the  solder  has  flowed  freely  at  the  first 
point,  it  will  be  comparatively  easy  to  fuse  it  at  all  the 
others,  as  the  temperature  of  the  whole  piece  will  be 
raised  so  high  by  this  time,  that  little  additional  heat  will 
be  necessary  to  fuse  the  solder  at  the  various  other  points 
where  it  is  required.  The  flame,  howrever,  when  it  is 
directed  to  a  single  point,  for  the  purpose  of  fusing  the 
solder  there,  should  be  brought  to  a  smaller  focus,  than 
when  first  thrown  upon  the  work  wTith  a  view  of  heating 
the  plaster. 

Should  the  solder  flow  in  a  wrong  direction,  as  it  often 


394       ATTACHING    THE    TEETH    TO    THE    PLATE. 

does,  when  the  heat  is  not  concentrated  upon  the  right 
place,  the  focus  of  the  flame  of  the  lamp,  should  be 
directed  upon  the  point  where  it  is  desired  it  should  take 
effect,  when  it  will  immediately  flow  in  that  direction. 
When  the  solder  is  only  partially  fused  it  is  apt  to  run 
together  and  form  a  lump  or  small  ball,  which  is  fused 
with  great  difficulty,  or  to  leave  a  rough  uneven  surface, 
and  thus  render  the  process  of  finishing  both  tedious  and 
troublesome. 

When  the  soldering  is  completed,  the  plaster,  after  it 
has  cooled,  should  be  removed,  and  the  work  immersed 
in  a  mixture  of  equal  parts  of  sulphuric  acid  and  water, 
for  the  purpose  as  before  stated,  of  decomposing  the 
borax  and  cleansing  the  plate.  From  fifteen  to  thirty 
minutes  are  required  for  this,  and  when  it  is  completed, 
the  work  should  be  taken  out,  washed  in  water,  and  all 
rough  portions  carefully  removed  with  suitable  scorpers 
(scrapers)  and  a  smooth  neat  finish  given  to  it.  This 
done,  it  is  ready  to  be  applied  to  the  mouth,  but  in  its 
insertion  it  is  often  necessary  to  bend  and  file  the  clasps 
a  little  to  complete  their  adaptation  to  the  teeth  which 
they  are  intended  to  encircle. 


CHAPTER    FOURTH. 

OF  THE  TEETH  TO  WHICH  IT  IS  MOST  PROPER  TO  APPLY  CLASPS, 
AND  THE  MANNER  OF  COUNTERACTING  THE  INJURY  LIABLE 
TO    RESULT    FROM    SUCH    APPLICATION. 

The  utility  of  artificial  teeth  applied  on  plate,  when 
retained  in  the  mouth  by  clasps  to  some  of  the  natural 
teeth,  depends  very  much  upon  the  teeth  to  which  they 
are  clasped.  The  first  molares,  when  sound  and  firmly 
articulated,  offer  a  better  means  of  support  to  a  dental 
substitute  than  any  of  the  other  teeth,  and  when  they 
can  be  as  conveniently  employed  for  this  purpose,  they 
should  certainly  be  preferred.  Next  to  these,  the  second 
molares  are  the  best,  and  next  to  these  the  second  bicus- 
pides,  then  the  first,  and  lastly  the  dentes  sapientiae.  But 
no  loose  tooth,  nor  one  within  whose  socket  there  is  a 
diseased  action,  or  which  is  so  much  affected  wTith  caries, 
that  it  cannot  be  restored  to  health,  should  ever,  when  it 
can  be  avoided,  be  made  a  means  of  support  to  artificial 
teeth.  When  none  but  such  can  be  had,  the  proper 
course  to  pursue,  is,  to  extract  every  tooth  in  the  jaw, 
and  replace  the  loss  of  the  whole,  with  artificial  substi- 
tutes, as  the  application  of  clasps  to  diseased  or  loose 
teeth,  always  aggravates  the  diseased  action,  and  causes 
them  to  become  a  source  of  increased  annoyance  to  the 
patient,  as  well  as  a  cause  of  disease  to  the  adjacent  and 
contiguous  parts.     This,  at  any  rate,  would  have  to  be 


396  TEETH    TO    WHICH    IT    IS 

done,  in  two  or  three  years,  and  it  is  better  to  do  it  at 
once,  than  to  subject  him  to  the  increased  trouble  and 
expense  consequent  upon  a  double  operation.  More- 
over, when  the  clasps  are  applied  to  loose  teeth,  the  arti- 
ficial ones  not  being  held  firmly  in  their  place,  move  up 
and  down  with  the  motions  of  the  lip,  and  thus  render 
their  detection  by  every  observer,  almost  inevitable. 

A  plate  with  artificial  teeth,  when  properly  fitted  and 
constructed,  exerts  but  little  mechanical  force  upon  the 
teeth  to  which  it  is  applied.  Therefore,  wTith  the  proper 
care  and  attention,  a  dental  substitute  of  this  description, 
may,  under  favourable  circumstances,  be  worn,  without 
being  altered  or  replaced  by  another,  from  ten  to  twenty 
years.  But  it  is  important  in  every  case,  that  the  clasps 
be  accurately  adapted,  and  applied  in  such  a  manner  as 
not  to  strain  or  exert  any  undue  pressure  upon  the  teeth 
to  which  they  are  fixed. 

The  cuspidati,  being  of  a  conical  shape,  and  wholly 
unsuited  to  the  application  of  clasps  for  the  retention 
of  artificial  teeth,  should  never,  when  it  can  possibly  be 
avoided,  be  used  for  that  purpose.  It  is  true,  they  are 
oftentimes  fixed  to  them,  but  the  practice  is  nevertheless 
objectionable.  But  when  from  peculiar  necessity,  it 
becomes  absolutely  requisite  to  use  these  teeth,  the  clasps 
should  be  adapted  with  great  accuracy,  and  in  such  a 
manner  as  to  prevent  their  presence  from  being  detected, 
which  can  only  be  done,  by  making  them  very  short  and 
narrow.  They  should  only  reach  a  little  more  than  half 
way  round  the  teeth,  and,  applied  very  near  to  the  gum. 

As  a  means  of  support  for  artificial  teeth,  the  incisores 
are  worse  than  the  cuspidati.  It  is  almost  impossible  to 
apply  clasps  to  these  teeth  so  as  to  hold  even  a  single 
artificial  tooth  securely  and  firmly  in  the  mouth,  still 
when  others  cannot  be  had,  it  is  sometimes  necessary  to 


MOST  PROPER  TO  APPLY  CLASPS.       397 

use  these,  but  they  should  only  be  had  recourse  to  as 
a  dernier  resort. 

Having  now  mentioned  the  teeth  to  which  it  is  most 
proper  to  apply  clasps,  it  will  be  proper  to  say  a  few 
words  concerning  the  means  necessary  for  the  prevention 
of  the  effects  liable  to  result  from  their  application.  It  is 
well  known,  not  only  to  practitioners  of  dentistry,  but 
also  to  most  persons  who  have  worn  artificial  teeth,  ap- 
plied upon  the  principle  under  consideration,  that  the 
liability  of  the  teeth  to  decay,  to  which  the  clasps  are 
applied,  is  always  increased  by  their  application.  The 
reason  of  this,  has  often  very  erroneously  been  ascribed, 
to  the  mechanical  action  of  the  clasps.  It  is  a  common 
remark,  even  among  dentists,  that  when  teeth,  to  which 
clasps  or  ligatures,  have  been  applied,  have  decayed; 
they  have  been  worn  off;  when  in  reality,  the  loss  of  sub- 
stance which  they  had  sustained,  was  wholly  attributable 
to  another  cause,  to  the  action  of  chemical,  not  to  that  of 
mechanical  agents.  By  the  retention  of  the  secretions  of 
the  mouth  and  other  extraneous  matter,  between  the 
clasps  and  the  teeth  to  which  they  are  applied,  they  soon 
become  putrid  and  acidulated,  decomposing,  first  the 
enamel,  and  afterwards  the  bony  structure  of  the  organs. 

This  being  the  cause  of  the  injury  sustained  by  teeth, 
to  which  clasps  are  applied,  the  means  for  its  prevention, 
must,  at  once,  suggest  themselves  to  every  reflecting 
mind.  They  consist  in  the  frequent  removal  of  the 
artificial  teeth,  and  the  cleansing  of  the  natural  ones,  to 
which  the  clasps  have  been  applied.  This  should  be  done 
every  morning  and  night,  immediately  after  rising,  and 
before  going  to  bed,  and  after  each  meal.  For  which 
purpose,  both  a  brush  and  waxed  floss  silk  should  be 
employed,  and  the  teeth  rubbed  until  every  particle  of 
vitiated  mucus  and  foreign  matter  is  removed. 
51 


398  TEETH  MOST  PROPER  TO  APPLY  CLASPS  TO. 

By  the  constant  and  regular  observance  of  these  means, 
the  decay  of  the  teeth  may  be  prevented :  but  if  neglected, 
their  destruction,  will,  in  most  cases,  be  both  speedy  and 
inevitable.  Therefore,  the  importance  of  attending  to 
them,  should  always  be  strongly  impressed  upon  the  mind 
of  the  patient,  who,  at  the  same  time,  should  be  properly 
instructed  in  the  manner  of  removing  and  replacing  the 
artificial  teeth,  and  the  plate  and  clasps  should  be  so  con- 
structed, that  this  may  be  done  with  the  most  perfect 
ease  and  convenience. 

But  the  decay  of  the  teeth  caused  by  the  presence  of 
corrosive  agents,  is  not  the  only  injury  liable  to  be  pro- 
duced by  the  application  of  clasps.  They  are  oftentimes 
so  fitted,  that  when  applied,  they  force  themselves  down 
between  the  necks  of  the  teeth  and  gums,  giving  rise  to 
inflammation  in  the  last-mentioned  structure  and  the  al- 
veolo-dental  membranes,  and  ultimately  to  the  destruction 
of  the  alveolar  processes,  and  the  gradual  loosening  and 
loss  of  the  teeth.  It  is  always  necessary,  therefore,  to 
guard  against  these  effects,  by  so  adapting  the  clasps  to 
the  teeth  as  to  prevent  them  from  pressing  too  much 
upon  the  gums. 


CHAPTER    FIFTH. 

OF    THE    CONSTRUCTION    OF    A    DOUBLE    SET    OF    ARTIFICIAL    TEETH 
MOUNTED    ON    PLATES    WITH    SPIRAL    SPRINGS. 

The  mouth  being  in  a  fit  condition,  an  impression  of 
each  alveolar  ridge  should  be  taken  in  wax,  from  which 
plaster  and  metallic  models  and  counter  models  should  be 
obtained.,  in  the  manner  as  before  described.  Between 
the  latter,  a  plate  for  each  jaw,  of  the  thickness  and 
width  before  mentioned,  should  be  swedged  and  properly 
fitted.  Having  proceeded  thus  far,  the  next  thing  to  be 
done,  is,  to  make  an  antagonizing  model,  which  may 
be  obtained  in  the  following  manner.  First,  take  a  thin 
piece  of  soft  wrood,  trim  off  its  edges  until  its  width  shall 
be  equal  to  the  length  it  is  intended  the  front  teeth  in 
both  jaws  shall  be,  then  fix  a  rim  of  softened  wax  about 
an  inch  or  an  inch  and  a  quarter  in  width,  between  the 
convex  surfaces  of  the  two  plates ;  next  pass  one  end  of 
the  wood  through  the  frame  part  of  this  about  on  the 
medial  line;  put  the  whole  in  the  mouth,  adjust  the  plates, 
each  to  its  proper  place,  then  direct  the  patient  to  close 
his  jaws  naturally  until  they  come  in  contact  with  the 
edges  of  the  wood,  when  his  mouth  should  be  opened 
and  the  plates  and  wax  removed,  without,  in  the  least, 
changing  their  relative  position.  The  concave  surfaces 
of  the  plates  should  now  be  oiled,  and  a  batter  of  plaster 
of  Paris,  put  first  on  one  side  and  then  on  the  other,  in 


400  DOUBLE    SET    OF    ARTIFICIAL    TEETH 

the  manner  as  directed  for  obtaining  an  antagonizing 
model  when  a  dental  substitute  is  required  for  only  one 
of  the  jaws. 

When  the  plaster  has  become  sufficiently  hard,  the 
two  pieces  may  be  separated,  and  the  wax  removed. 
This  done,  let  a  narrow  rim  of  wax  be  put  around  the 
convex  surface  of  each  plate,  which  is  supposed  to  be 
still  connected  with  its  own  part  of  the  model.  The  two 
parts  of  the  model  may  now  be  put  together,  and  the 
teeth  selected  and  arranged  on  the  w7ax,  beginning  with 
the  superior  central  incisores,  then  with  the  inferior,  and 
so  on;  first,  with  two  in  the  upper  and  then  with  two  in 
the  lower  jaw,  until  all  are  selected  and  arranged. 

As  a  general  rule,  the  upper  incisores  and  cuspidati 
should  overlap  the  lower,  and  the  superior  centrals 
should  cover  the  inferior  centrals  and  about  one-half  of 
the  laterals.  The  upper  lateral  incisores  should  cover 
the  lower  laterals,  and  about  one-half  of  the  inferior  cus- 
pidati, and  the  superior  cuspidati  should  cover  the  re- 
maining half  of  the  lower  and  about  one-half  of  the  first 
inferior  bicuspides.  The  first  superior  bicuspides  should 
cover  the  remaining  half  of  the  first  inferior  and  about  one- 
half  of  the  second,  and  the  second  superior  bicuspides 
should  cover  the  remaining  half  of  the  second  inferior 
and  about  one-third  of  the  first  molares.  The  first  upper 
molares  should  cover  the  remaining  two-thirds  of  the  first 
lower  and  about  one-third  of  the  second ;  and  lastly,  the 
second  superior  molares  should  cover  the  remaining  two- 
thirds  of  the  second  inferior.  The  third  molares,  or 
dentes  sapientiae,  are  usually  dispensed  with  in  a  set  of 
artificial  teeth. 

The  foregoing  arrangement  being  about  that  of  the 
natural  teeth,  should  always  be  observed  in  the  con- 
struction of  an  artificial  set,  for  the  reason,  that  it  adds  to 


WITH    SPIRAL    SPRINGS.  401 

their  strength  as  well  as  to  the  beauty  of  their  ap- 
pearance. 

In  fitting,  arranging,  and  antagonizing  a  double,  as  well 
as  a  part  of  a  set  of  artificial  teeth,  it  is  almost  always 
necessary  to  alter  the  shape  of  their  base  or  the  part 
which  is  to  be  fitted  to  the  plate,  and  this  can  only  be 
done  by  means  of  an  emery  wheel  or  grind  stone. 

The  teeth  being  all  properly  adjusted  and  antagonized, 
the  operator  should  next  proceed  to  make  suitable  sup- 
ports for  the  springs.  These  are  differently  constructed 
by  different  dentists,  but  the  simplest,  and  if  not  the  best, 
that  have  ever  been  employed,  consist  of  strips  of  gold 
about  an  eighth  of  an  inch  in  width,  the  sixteenth  or  twen- 
tieth of  an  inch  in  thickness,  and  about  a  fourth  or  three- 
eighths  of  an  inch  in  length,  with  a  shallow  open  socket 
on  the  outside  of  the  end  towards  the  coronal  extremities 
of  the  teeth,  for  the  head  of  the  eyelet,  perforated  in  the 
centre  for  the  reception  of  a  screw,  or  simply  with  a  very 
narrow  strip  of  gold,  a  little  thicker  than  the  head  of  the 
eyelet,  soldered,  transversely  across,  a  little  below  the 
perforation  for  the  screw,  to  prevent  the  spring  from  com- 
ing in  contact  with  the  gums.  The  other  extremities  of 
these  supports  are  soldered  to  the  plate,  one  on  each  side 
on  the  outside  of  the  teeth,  at  a  proper  point  between  the 
medial  line  and  the  posterior  extremities,  which,  in  most, 
if  not  in  all  cases,  will  be  found  to  be  between  the  second 
bicuspides  and  first  molares.  The  screw-heads  should 
be  a  little  larger  than  the  heads  of  the  eyelets,  which  last 
should  be  about  a  twelfth  of  an  inch  in  diameter.  The 
screws  need  not  be  larger  than  a  small  knitting-needle. 
The  object  of  having  large  heads  to  them  is  to  prevent 
the  springs  from  coming  in  contact  with  the  walls  of  the 
cheek. 

The  arm  of  the  eyelet  or  the  part  intended  to  enter  the 


402  DOUBLE    SET    OF    ARTIFICIAL    TEETH 

spring  should  be  about  half  an  inch  long,  and  the  size  of 
the  spindle  or  wire  around  which  the  spring  is  wound. 

The  springs  should  be  made  from  eighteen  carot  gold 
wire,  which  should  be  no  larger  than  is  necessary  to 
give  to  them  a  sufficient  degree  of  power.  Their  diame- 
ter should  not  exceed  a  tenth  or  at  most  an  eighth  of  an 
inch.  Their  length  should  be  varied  from  an  inch  and  a 
half  to  two  inches,  according  to  the  distance  of  the  jaws 
from  each  other  when  the  mouth  is  opened  to  its  greatest 
extent. 

The  manner  of  winding  the  wire  is  very  simple.  It  is 
sometimes  done  by  means  of  a  small  crank,  but  the  sim- 
plest way  of  doing  it  is  to  grasp  it  between  two  blocks  of 
wood  in  a  small  bench-vice.  This  done,  let  the  upper 
end  be  grasped  with  the  wire  or  spindle  on  which  it  is 
to  be  wound,  which  should  not  exceed,  in  size,  a  small 
knitting-needle,  by  a  pair  of  sliding  tongs  or  a  small 
hand-vice.  This  then,  with  the  end  of  the  spindle  rest- 
ing on  the  blocks  of  wood,  should  be  made  to  revolve  by 
turning  it  in  the  hand,  until  a  coil  of  sufficient  length 
shall  have  been  firmly  and  closely  wound  on  the  spindle. 

But  the  construction,  both  of  the  springs  and  sup- 
ports, will  be  better  understood  by  the  student,  by  an 
examination  of  Plate  XXIX.  Fig.  8,  where  they  are 
represented,  than  by  any  description  which  can  be  given. 

It  is  often  necessary  to  employ  spiral  springs  for  the 
support  of  an  upper  and  part  of  a  lower  set  of  artificial 
teeth;  as  for  example,  where  only  three  or  four  teeth  are 
required  on  each  side  of  the  back  part  of  the  inferior 
maxillary — six  or  eight  of  the  natural  teeth  in  the  front 
part  of  the  mouth  being  present  and  firmly  articulated. 
The  lower  plate,  in  a  case  of  this  sort,  should  pass  behind 
the  natural  teeth  which  remain,  and  cover  the  alveolar 
ridge  posteriorly  where  they  are  wanting.     But  the  part 


WITH    SPIRAL    SPRINGS.  403 

of  the  plate  which  passes  behind  the  natural  teeth  should 
be  thickened,  by  soldering  another  piece  over  it,  to  give 
it  the  necessary  degree  of  stiffness  and  prevent  it  from 
bending.  It  is  seldom,  however,  that  a  set  of  teeth  con- 
structed in  this  manner,  is  worn  with  as  much  comfort 
and  satisfaction  as  a  full  set,  and  where  only  five  or  six 
teeth  remain,  it  would  be  better  to  extract  them  and  in- 
sert a  complete  set  at  once;  or  if  there  be  eight  good 
teeth,  or  even  six,  in  the  front  part  of  the  mouth  in  the 
lower  jaw,  to  dispense  with  a  substitute  for  the  others, 
and  apply  only  an  upper  set. 


CHAPTER    SIXTH. 

OF     THE     CONSTRUCTION     OF     PLATES     FOR     ARTIFICIAL     TEETH     IN 
PARTICULAR    CASES. 

As  the  stability  of  artificial  teeth,  applied  on  plate, 
greatly  depends  on  the  construction  o£  the  plate,  it  may 
be  well  to  describe  the  shape  that  should  be  given  to  it; 
in  a  few  different  cases.  But  the  reader  will  be  able  to 
form  a  more  correct  idea  of  their  shape  and  the  manner 
of  their  application,  from  the  representations  given  in 
Plates  XXVIII.  and  XXIX.,  than  from  any  description 
which  can  be  given.     To  these,  therefore,  he  is  referred. 

It  is  seldom  necessary,  in  the  application  of  a  single 
incisor  to  attach  to  the  plate  more  than  one  clasp.  If 
this  be  applied  to  a  suitable  tooth,  it  will  give  to  the  plate 
and  artificial  organ  sufficient  stability  for  all  the  purposes 
to  which  a  substitute  for  a  single  tooth  can  be  made  sub- 
servient. The  plate  should  be  about  a  quarter  of  an 
inch  in  width  and  carried  back  on  the  palatine  side  of  the 
alveolar  ridge,  to  the  second  bicuspis  or  first  molares,  of 
the  same  side,  if  either  of  these  are  remaining^  and  are 
in  a  suitable  condition  to  be  employed  for  its  support. 
But  when  these  teeth  are  wanting,  and  no  other  suitable 
tooth  on  this  side  of  the  mouth  can  be  had,  the  plate 
should  be  carried  across  to  a  bicuspis  or  molaris  on  the 
other  side,  to  which  it  should  be  clasped.  In  either  case, 
however,  the  plate  should  not  be  fitted  up  close  to  the 


PLATES  FOR  TEETH  IN  PARTICULAR  CASES.  405 

teeth  by  which  it  passes.  A  space  of  a  twelfth  or  an 
eighth  of  an  inch  should  be  left  between  it  and  them,  so 
that  it  may  not  become  a  cause  of  irritation  to  the  apices 
and  margin  of  the  gums.  The  anterior  edge  of  the  plate 
should  not  ordinarily  come  so  far  forward  over  the  alveo- 
lar ridge,  as  to  prevent  the  anterior  part  of  the  base  of 
the  tooth  from  covering  it. 

But  when  from  any  peculiarity  in  the  shape  of  the 
bicuspides  and  molares,  one  cannot  be  found  capable  of 
affording  a  sufficiently  firm  support  for  a  clasp,  or  that 
will  not  admit  of  the  application  of  one  sufficiently  wide 
to  do  this,  then  the  plate  should  be  extended  back  on 
each  side,  to  the  second  bicuspides  or  first  molares,  or  to 
the  teeth  which  it  is  to  be  clasped. 

The  foregoing  general  directions  with  regard  to  the 
construction  of  a  plate  for  an  artificial  incisor,  will,  in 
most  instances,  serve  as  a  sufficient  guide  to  the  student 
or  young  practitioner,  yet  cases  will  occasionally  present 
themselves,  in  which  his  judgment  alone,  will  have  to 
suggest  the  description  of  plate  that  it  will  be  most  proper 
to  employ. 

When  two  or  more  incisores  of  the  superior  maxillary 
are  to  be  replaced  with  artificial  teeth  applied  on  a  metal- 
lic base,  the  part  of  the  plate  to  which  the  teeth  are  to  be 
attached  should  be  from  three-fourths  of  an  inch  to  an 
inch  in  width,  and  extend  back  on  each  side  of  the  al- 
veolar ridge  to  the  second  bicuspides,  or  first  or  second 
molares,  or  whichever  may  afford  the  best  means  of  sup- 
port to  the  artificial  piece  to  be  placed  in  the  mouth. 
And,  as  in  the  case  of  the  plate  for  a  single  tooth,  it 
should  come  as  far  forward  over  the  alveolar  ridge,  as 
the  anterior  portion  of  the  base  of  the  artificial  teeth  will 
admit.  This  part  of  the  plate,  except  in  those  cases  in 
which  the  gums  are  never  exposed  in  laughing,  should 
52 


406  PLATES  FOR  TEETH  IN  PARTICULAR  CASES. 

be  covered  by  the  artificial  teeth  to  prevent  its  presence 
from  being  detected. 

A  plate  of  this  description  when  firmly  secured  by  a 
clasp  to  a  bicuspis  or  molaris  on  each  side  of  the  mouth, 
will  afford  a  secure  support  to  substitutes  for  all  of  the 
incisores  and  even  the  cuspidati;  and  artificial  teeth  thus 
applied,  may  be  made  to  subserve  to  a  very  great  extent, 
all  the  purposes  of  the  natural  organs  whose  loss  they 
supply. 

In  constructing  a  metallic  base  for  the  incisores,  cuspi- 
dati and  bicuspides,  the  plate  should  be  shaped  very  much 
like  the  one  last  described,  except  that  it  should  be  about 
the  same  width  all  the  way  round.  It  should  be  accu- 
rately fitted  to  the  teeth  to  which  the  clasps  are  to  be 
applied,  and  be  fully  one  inch  in  width.  The  loss  of  all 
the  teeth  in  the  upper  jaw  as  far  back  even  as  the  dentes 
sapientiae,  may  be  replaced  with  artificial  teeth  attached 
to  a  plate  of  this  description.  But  when  it  is  to  be  clasped 
to  the  second  molares,  if  the  third  be  wanting  or  have 
been  removed,  it  should  be  extended  back  to  the  maxillary 
tuberosity  on  each  side,  to  prevent  its  weight,  together 
with  that  of  the  artificial  teeth,  from  acting  unequally  and 
prejudicially  on  the  organs  that  sustain  it. 

It  frequently  becomes  necessary  to  supply  the  loss  of 
one  or  more  upper  incisores  as  well  as  the  bicuspides  and 
sometimes  one  or  two  molares  on  one  side  of  the  mouth, 
by  means  of  a  plate  secured  by  clasps  to  teeth  on  the 
other  side.  In  cases  of  this  sort,  the  plate  should  be 
made  to  cover  such  parts  of  the  alveolar  ridge  as  are  to 
be  supplied  with  artificial  teeth,  and  to  fit  up  closely  to 
the  teeth  to  which  it  is  to  be  applied,  and  when  practica- 
ble, the  second  bicuspis  and  second  molaris  should  be 
selected  for  this  purpose.  By  attaching  clasps  to  the 
plate  at  points  a  little  distant  from  each  other,  greater 
stability  will  be  secured  to  the  piece. 


PLATES    FOR    TEETH    IN    PARTICULAR    CASES.      407 

It  is  seldom  necessary,  in  the  application  of  substitutes 
for  one  or  two  bicuspides  on  each  side  of  the  mouth,  to 
extend  a  plate  across  from  one  side  to  the  other.  Two 
separate  plates  may  be  employed,  and  each  made  fast  to 
a  molaris.  When  thus  applied,  they  are  worn  with  more 
comfort  and  satisfaction  by  the  patient,  than  when  the 
plate  is  extended  all  the  way  across  the  mouth,  however 
accurately  it  may  be  fitted. 

In  constructing  a  plate  for  artificial  substitutes  to  sup- 
ply the  place  of  all  the  natural  teeth  in  the  upper  jaw, 
except  a  single  molaris,  it  should  be  about  one  inch  in 
width,  and  made  to  cover  as  much  of  the  alveolar  ridge 
as  possible,  and  to  all  the  inequalities  of  which,  it  should  be 
accurately  fitted.  It  should  extend  back  of  the  remain- 
ing natural  tooth  to  the  tuberosity  of  the  bone,  which  it 
should  cover.  The  clasp  should  be  wide  and  applied  in 
such  a  manner  as  to  keep  the  plate  in  its  proper  place. 
A  single  molaris  may  oftentimes  be  made  the  means  of 
support  to  a  plate  with  twelve  or  thirteen  artificial  teeth 
for  a  number  of  years,  but  as  a  general  rule,  when  there 
is  only  a  single  tooth  remaining,  it  is  better  to  extract  it 
and  apply  a  whole  upper  set  upon  the  atmospheric  pres- 
sure or  suction  principle ;  for  the  reason,  that  the  opera- 
tion can  be  made  more  perfect  and  durable. 

Most  dentists  are  in  the  habit,  in  the  application  of 
artificial  teeth  upon  the  last-mentioned  principle,  to  make 
the  plate  wide  enough  to  cover  the  whole  of  the  roof  of 
the  mouth,  but  in  doing  this,  it  is  impossible  to  fit  it  with 
as  much  accuracy  to  the  various  inequalities  of  the  parts 
as  can  be  done,  when  a  narrower  one  is  employed.  A 
plate,  an  inch  or  an  inch  and  a  fourth  in  width  can,  for 
this  reason,  be  made  to  adhere  more  firmly  than  a  much 
wider  one. 


CHAPTER    SEVENTH. 

OF    ARTIFICIAL    OBTURATIONS    AND    PALATES. 

Before  giving  a  description  of  the  mechanical  contri- 
vances most  proper  to  be  employed  for  remedying  the 
various  defects  met  with  in  the  palatine  organs,  it  will  be 
proper  to  offer  a  few  general  remarks  concerning  the 
nature  and  extent  of  the  injury  to  which  these  parts  are 
liable. 

ABSENCE  OF  A  PORTION  OF  THE  PALATINE  ORGANS. 

Imperfections  in  the  palatine  arch,  involving  a  loss  of 
substance,  always  interferes,  in  proportion  to  their  nature 
and  extent,  with  the  functions  of  mastication  and  deglu- 
tition, and  this  difficulty  is  greatly  aggravated,  when  the 
defects  here,  are  accompanied  by  malformation  of  the 
jaws.  But  notwithstanding  the  inconvenience  to  wThich 
an  individual,  labouring  under  an  affection  so  distressing 
as  that  of  the  absence  of  the  whole  of  the  palatine  arch, 
and  even  a  portion  of  the  anterior  part  of  the  alveolar 
border,  together  with  a  fissure  of  the  upper  lip,  they  do, 
nevertheless,  manage  to  perform  these  functions;  and  it  is 
curious  to  see  how  readily  an  infant,  thus  affected,  draws 
from  the  breast  of  its  mother  or  nurse,  the  aliment  which 
it  requires  for  its  sustenance  and  growth.  The  plan 
which  it  adopts  to  effect  this  process,  is  very  curious. 


ABSENCE    OF    A    PART    OF    PALATINE    ORGANS.     409 

The  nipple,  instead  of  being  taken  upon  the  top  of  the 
tongue,  is  carried  beneath  it,  and  this  organ,  as  is  ob- 
served by  M.  Delabarre,  is  thus  made  to  perform  the 
office  of  an  obturator,  by  being  applied  to  the  roof  of  the 
mouth  and  closing  the  opening  through  it.  It  now,  by 
the  contraction  of  its  lips  and  depression  of  its  tongue, 
draws  the  milk  from  the  breast. 

Unconscious  of  the  imperfection  in  its  palate,  it  does 
not  perceive,  as  is  observed  by  the  author  just  mentioned, 
until  the  period  approaches,  when  it  should  begin  to 
make  its  wants  known  by  words,  the  great  importance  of 
a  distinct  articulate  voice.  This  function,  in  conse- 
quence of  which,  is  little  cultivated.  Every  word  being 
badly  articulated,  it  <e makes  no  effort  to  render  itself  in- 
telligible. All  the  sounds  are  nasal,  and  resemble  a  dull 
murmur,  difficult  to  understand,  and  disagreeable."  Nor 
can  age  enable  the  unfortunate  individual  to  give  a  much 
more  distinct  utterance  to  words. 

Imperfections  of  the  palatine  arch  are  sometimes  con- 
genital; at  other  times  they  are  the  result  of  disease,  or 
of  mechanical  violence.  The  former  are  seldom  unac- 
companied by  a  fissure  of  the  upper  lip,  and  sometimes 
two,  and  the  division  or  perforation  of  the  palate,  is 
always  along  the  median  line.  This  description  of 
defective  formation,  extends  both  to  the  bones  and  soft 
parts,  causing  the  cavities  of  the  nose  to  communicate  with 
that  of  the  mouth.]  There  is  much  variety  in  them,  in 
some,  there  is  deficiency  of  the  velum  pendulum  palati, 
or  soft  palate;  in  others,  there  is  a  fissure  extending 
through  the  whole  roof  of  the  mouth,  both  the  bony  and 
soft  parts  being  divided. 

[There  is  sometimes  too,  a  complete  division  of  the  al- 
veolar border,  oftentimes  accompanied,  by  great  distortion 
of  the  jaw-bone.     Mr.  Fox,  describes  a  most  extraordi- 


410       ABSENCE    OF    A    PART    OF    PALATINE    ORGANS. 

nary  case,  which  came  under  the  care  of  Mr.  Heaviside.* 
He  says.]  It  was  in  a  young  gentleman  born  with  a 
double  harelip;  the  upper  jaw  bone  projected  considerably 
under  the  nose.  When  the  time  of  dentition  arrived, 
three  teeth  came  in  this  projecting  piece,  and  the  ap- 
pearance of  the  mouth  was  as  in  Plate  XXII.  Fig.  1. 
At  the  time  that  Mr.  Heaviside  was  first  consulted,  he 
advised  that  no  operation  should  be  attempted  until  the 
young  gentleman  had  arrived  at  an  age  when  the  success 
of  the  operation  would  have  no  chance  of  defeat  from 
childish  resistance.  When  he  was  about  six  years  of 
age,  Mr.  Heaviside  began  to  perform  the  operation ;  at 
that  time  he  dissected  from  the  bone  a  piece  of  skin 
which  grew  upon  the  upper  surface;  he  then  sawed  off 
the  projecting  piece,  with  three  teeth  in  it,  Fig.  2.  Twelve 
months  afterwards,  he  performed  the  operation  for  hare- 
lip on  one  side.  He  then  left  his  patient  for  another 
year,  when  he  performed  the  like  operation  on  the  other 
side.  The  piece  of  skin  that  had  been  attached  to  the 
upper  surface  of  the  bone,  formed  the  central  portion  of 
the  lip;  and  when  the  cure  was  completed,  the  face  ap- 
peared as  in  Fig.  3,  having  a  most  perfect  symmetry,  and 
free  from  any  deformity. 

[It  is  to  be  regretted,  that  the  extent  of  the  imperfection 
in  the  palatine  arch  in  the  foregoing  case,  is  not  described. 
Nor  does  it  appear  from  the  history  which  the  author  has 
given  of  it,  that  any  surgical  operation  was  performed,  or 
mechanical  contrivance  applied  to  remedy  this  part  of  the 
defect.  But  when  recourse  is  had  to  mechanical  means 
as  a  substitute  for  the  absence  of  any  portion  of  the  roof 
of  the  mouth,  or  palate,  it  should  not  be,  until  after  the 
completion  of  the  growth  of  the  jaws,  and  it  may  be,  that 
the  employment  of  means  for  remedying  the  defect   in 

*  Vide  Plate  XXII. 


ABSENCE    OF    A    PART    OF    PALATINE    ORGANS.     411 

these  parts,  was  for  this  reason  deferred  to  a  later  period 
of  life,  which  may  not  have  been  until  after  the  publica- 
tion of  this  work. 

M.  Delabarre,  who  in  his  work  on  mechanical  dentis- 
try, treats  of  the  subject  in  question  at  some  length, 
divides  accidental  leisons  of  the  palatine  organs,  into 
three  species.  The  first  is  circumscribed  by  the  osseous 
substance.  The  second  consists  of  a  perforation  of 
the  velum  of  the  palate  only;  and  the  third,  in  the 
destruction  of  the  entire  vault  of  the  palate,  or  at  least,  a 
great  part  of  it;  and  to  these  ravages,  is  sometimes  added, 
says  the  author  just  named,  the  loss  of  the  inferior  portion 
of  the  vomer  and  the  cornets. 

"The  two  first,"  says  Delabarre,  "are  most  frequently 
situated  on  the  side  of  the  palatine  raphe,  thus  penetrating 
only  a  single  nostril."  He  then  adds,  that,  whatever  be 
the  extent,  form  and  position  of  these  accidental  leisons 
the  victims  of  them  have  not  the  advantage  of  the  young 
infant;  for  having  acquired  the  habit  of  eating  by  placing 
their  food  on  the  tongue,  they  always  force  a  certain 
quantity  of  it  up  into  the  nose.  The  natural  tone  of  the 
voice  is  destroyed,  articulation  of  words,  in  some  cases, 
where  the  loss  of  substance  is  very  considerable,  is  wholly 
prevented.  They  also  affect  deglutition  as  well  as  the 
voice.  The  case  of  a  young  man,  is  mentioned  by  the 
above  named  writer,  who,  suffering  from  a  division  of 
the  velum  palati,  could  swallow  no  fluids,  "without  a 
part  of  them  being  returned  by  the  nose."  He  however 
managed  to  remedy  to  some  extent,  this  difficulty,  by 
throwing  his  head  back,  and  letting  them  run  into  the 
oesophagus.  Similar  examples  of  effects  resulting  from  a 
loss  of  a  portion  of  the  palatine  organs  have  fallen  under 
the  observation  of  the  editor. 

In  the  destruction  of  the  solid  tissues  which  enter  into 


412      CONSTRUCTION  OF  OBTURATORS. 

the  formation  of  the  roof  of  the  mouth,  the  soft  parts 
participate.  Nor  does  the  injury  always  stop  here.  It 
frequently  extends  to  the  nose,  lips  and  cheeks;  the 
greater  portion  of  which,  are  sometimes  destroyed,  giving 
to  the  unhappy  sufferer,  the  most  hideous  and  frightful 
appearance,  but  as  it  constitutes  no  part  of  the  design  of 
the  editor  to  treat  of  the  means  employed  for  remedying 
defects  in  these  parts,  although  the  aid  of  art  is  often 
invoked,  and  has  in  many  instances  supplied  the  loss 
with  useful  and  ingenious  mechanical  contrivances,  he 
will  not  in  this  place,  attempt  to  give  a  minute  description 
of  them. 

Imperfections  of  the  palate  may  oftentimes  be  remedied 
by  surgical  means — by  an  operation,  denominated  staphy- 
loraphy,  said  to  have  been  first  instituted  by  a  French 
dentist  by  the  name  of  La  Monnier,  and  who  first  per- 
formed it  about  the  year  1764.  M.  Roux,  a  French 
surgeon,  is  the  author  of  an  excellent  memoir  on  this 
operation,  which  was  published  in  1825.  It  is  also 
minutely  described  by  Dr.  Hullihen  of  Wheeling,  Va. 
in  a  well  written  paper  in  the  fifth  volume  of  the  Ameri- 
can Journal  of  Dental  Science.  But  with  the  surgical 
treatment  of  leisons  of  the  palatine  organs,  the  editor  at 
present,  has  nothing  to  do;  his  object  being  merely  to 
describe  the  mechanical  means  employed  for  remedying 
them. 

OF  THE  CONSTRUCTION  OF  OBTURATORS. 

The  employment  of  obturators  to  supply  the  abscence 
or  replace  the  loss  of  a  portion  of  the  palatine  arch,  was 
resorted  to,  many  centuries  ago,  but  their  construction, 
for  a  long  time,  was  exceedingly  faulty,  and  as  a  conse- 
quence, the  wearing  of  them  was  not  only  attended  with 


CONSTRUCTION  OF  OBTURATORS.       413 

inconvenience,  but  was  also  productive  of  actual  injury. 
They  were  retained  by  means  of  a  piece  of  sponge. 
This  instrument,  according  to  Guillemean,  was  applied 
by  the  Greek  physicians,  who  called  it  hiperari.  But  as 
the  disease  to  which  the  destruction  of  the  palatine 
organs  were  supposed  to  be  only  attributable,  was  not 
known  at  so  early  a  period,  some  have  questioned  the 
correctness  of  the  above  statement.  On  the  other  hand, 
it  has  been  shown,  that  dental  abscesses  have  been  known 
to  give  rise  to  necrosis  and  exfoliation  of  the  bones  of  the 
palate,  and  that  hence  it  is  rendered  very  probable. 

The  celebrated  French  surgeon,  Ambrose  Pare,  gives 
an  engraving  of  an  obturator  which  he  had  constructed  in 
1585,  which  consisted  of  a  plate,  probably  of  gold  or 
silver,  applied  to  the  opening  in  the  palatine  arch,  and 
retained  by  means  of  a  piece  of  sponge,  secured  with  a 
screw  to  an  upright  attached  to  the  upper  surface  of  the 
plate.  The  sponge,  by  absorbing  the  moisture  in  the 
nostrils,  swelled  sufficiently  to  prevent  the  plate  from 
falling.  But  this  description  of  obturator  is  the  most 
objectionable  of  any  that  has  ever  been  employed.  By 
the  stagnation  of  the  fluid  in  the  sponge,  we  are  told,  and 
as  any  one  might  readily  suppose,  it  soon  becomes  so 
insufferably  offensive,  as  to  render  the  approach  of  an  indi- 
vidual almost  impossible.  Besides,  the  sponge  not  only 
counteracts  the  efforts  made  by  nature  to  effect  a  cure, 
but  it  has  been  found,  that  it  gradually  enlarges  the 
opening.  The  following  case,  quoted  from  Lefoulon, 
and  by  this  author,  from  a  memoir  upon  obturators,  by 
M.  Baillif,  a  dentist  of  Berlin,  is  in  point. 

"The  1st  of  November,  1824,"  he  says,  "Dr.  Siedmo- 
grodzki  presented  himself  to  me  with  M.  de  ***,  who 
had  had  the  misfortune  to  lose  his  nose,  and  part  of  the 


53 


414  CONSTRUCTION    OF    OBTURATORS. 

vault  of  the  palate;  by  a  siphilitic  malady,  in  the  years 
1807,  1808. 

The  hole  formed  in  the  anterior  of  the  palate  was  ten 
millimetres  long  and  eight  wide. 

To  remedy  these  accidents,  an  artificial  nose  had  been 
made  for  him,  and  an  obturator  formed  of  a  plate  of  fine 
silver,  furnished  with  a  sponge,  such  as  recommended  by 
Ambrose  Pare,  Gariot  and  other  practitioners  of  our 
days.  The  compression  which  the  sponge  of  the  said 
obturator  had  caused  upon  the  maxillary  and  palatine 
bones,  during  the  period  extending  between  the  years 
1808  and  1824,  has  so  dilated  the  parts,  that  all  the  max- 
illary and  palatine  vault  is  consumed  entirely,  without 
any  sign  of  disease,  and  in  an  imperceptible  manner, 
leaving  nothing  but  the  velum  and  uvula  at  the  posterior 
part.  The  anterior  part  of  the  maxillary  bones  is  so  thin 
that  they  are  separated  at  their  suture,  in  such  a  way  that 
the  obturator  could  no  longer  be  applied. 

In  short,  the  opening,  which  was  only  twelve  milli- 
metres long  and  fourteen  broad,  to  day  presents  the 
enormous  extent  of  ten  inches  long  and  an  inch  and  a 
half  broad.  Such  was  the  deplorable  situation  of  this 
patient,  who  could  not  articulate  a  single  syllable.  All 
the  sounds  that  she  could  utter  by  any  effort,  amounted 
to  no  more  than  a  kind  of  bellowing. 

This  fact  proves  incontestibly,  that  we  should  banish 
from  use,  obturators  sustained  upon  the  lateral  parts  by 
the  compression  of  sponges;  also,  those  wTith  wings, 
plates  and  flat  springs,  because  they  dilate  and  destroy 
every  part  which  they  touch  either  by  compression  or 
friction." 

In  speaking  of  the  application  of  any  appliance  which 
may  interfere  with  the  curative  efforts  of  the  economy, 
Bourdet,  thus  judiciously  remarks.     "  Before  considering 


CONSTRUCTION  OF  OBTURATORS.      415 

the  cicatrized  perforations  of  the  palate  as  being   of  a 
nature  incapable  of  diminishing  in  diameter,  practitioners 
should  satisfy  themselves  properly  and  beyond  doubt  that 
such  is  the  case.     I   do  not  think  so,  for  positive  facts 
attest  the  contrary,  and  as  holes  made  in  the  cranium 
with  the  trepan,  close  almost  entirely,  in  like  manner, 
those  of  the   palate   constantly  diminish."     The  juxta- 
posed obturator  proposed  by  Bourdet,  and  as  improved  by 
Delabarre,  is  free  from  the  objections  of  those  fastened 
with   sponge,  or   lateral   wings   or   slides,  which,  for   a 
long  time,  were  employed.     The  obturator  contrived  by 
Bourdet  consists  of  a  metallic  plate,  large  enough  to  cover 
the   opening   in  the  palate,  accurately  fitted,  with   two 
lateral  prolongations  extending  to  the  teeth  and  to  which 
they  were  fastened  by  means  of  ligatures.     But  as  the 
ligatures  were  productive  of  irritation  to  the  gums,  and 
did  not  hold  the  plate  sufficiently  tight  to  prevent  it  from 
moving,  it  found  but  little  favour  among  dentists.    Both  of 
these  objections,  however,  were  obviated  by  the  improve- 
ment  made  by  Delabarre,  which  consisted  in   the  em- 
ployment of  clasps,  attached  to  the  lateral  branches  of 
the  plate,  instead  of  ligatures,  for  fastening  it  to  the  teeth. 
And  to  prevent  these  from  slipping,  he  attached  to  each  a 
small  metallic  spur,  which,  descending  between  the  teeth, 
was  bent  below  over  its  grinding  surface.     To  this  im- 
provement he  made  another  equally  valuable,  not  only 
for  the  purpose  for  which  he  applied  it  in  a  case    he 
relates,  in  connection  with  the  description  he  gives  of  it, 
viz.  to  supply  the  loss  of  substance  and  prevent  an  accu- 
mulation of  mucus  in  the  cul  de  sac,  resulting  from  the 
wound  being  closed  only  on  the  side  of  the  mouth,  but 
also,  to  prevent  fluids  in  swallowing,  from  passing  be- 
tween the  obturator  and  soft  parts,  through  the  opening 
into  the  nostrils,  which  by  the  contraction  of  the  muscles 
of  the  palate  are  sometimes  slightly  raised. 


416  CONSTRUCTION    OF    OBTURATORS. 

This  last  improvement  consists  in  the  application  of  a 
drum  to  the  top  of  the  plate,  which,  to  use  the  author's 
own  words,  "  resembles  a  man's  hat,  the  crown  of  which 
is  very  low  and  enters  the  opening."  It  is  fastened  to  the 
plate  by  means  of  two  screws.  He  supplied  his  patient 
with  several  of  these,  gradually  diminishing  in  size,  so 
that  as  the  opening  closes,  a  smaller  one  may  be  put  on. 

A  copy  of  the  engraving  of  the  obturator  just  de- 
scribed, as  given  by  M.  Delabarre  in  his  Treatise  on 
Mechanical  Dentistry,  may  be  seen  in  Plate  XXX. 
Fig.  5. 

The  manner  of  constructing  an  obturator  after  the 
above  plan  is  very  simple.  First,  let  an  impression  be 
taken  in  wax  of  the  palatine  vault,  and  alveolar  ridge, 
then  procure  a  plaster  and  metallic  model  and  counter 
model,  in  the  manner  as  before  described.  Between  the 
last,  let  a  gold  plate  be  stamped,  large  enough  to  cover 
the  opening  in  the  palate,  with  an  arm  on  each  side  ex- 
tending  to  a  bicuspis  or  molar  tooth  to  which  a  broad 
clasp  should  be  soldered.  Second,  let  an  impression  of  the 
opening  be  now  taken,  and  from  this  another  plaster  and 
metallic  model  and  counter  model  obtained,  and  a  plate 
smaller  than  the  first  stamped — to  the  upper  surface  of 
which,  it  should  be  fitted  and  made  fast  by  soldering. 
But  the  drum  should  never  be  so  large  as  to  press  against 
the  walls  of  the  opening.  But  this  last,  should  never  be 
applied,  except  absolutely  required,  to  prevent  the  pas- 
sage of  fluids  into  the  nostrils. 

Every  part  of  the  mechanism  should  fit  with  the  most 
perfect  accuracy,  and  in  such  a  manner  as  not  to  be  pro- 
ductive of  the  slightest  irritation  to  the  soft  parts,  and  as 
in  the  case  of  the  insertion  of  artificial  teeth,  the  health 
of  the  natural  teeth  and  their  relative  and  contiguous 
parts  should  be  previously  secured.     This  should  never 


OBTURATORS    AND    PALATES    WITH    TEETH.        417 

be  lost  sight  of,  as  the  success  and  durability  of  the  ope- 
ration will  greatly  depend  on  it.  The  obturator  too, 
should  be  removed  and  thoroughly  cleansed  two  or  three 
times  every  day,  as  also  the  teeth  to  which  the  clasps  are 
applied. 

A  plate  of  gold  replacing  nearly  the  whole  of  the  loss 
of  the  entire  palate,  may  be  applied  in  the  manner  as 
just  described. 


OF   OBTURATORS    AND    PALATES   COMPLICATED  WITH   ARTIFI- 
CIAL  TEETH. 

The  loss  of  one  or  more  teeth  oftentimes  accompanies 
the  destruction  of  the  palate,  and  when  this  happens,  the 
substitute  for  the  latter  should  be  connected  with  that  for 
the  former,  and  the  idea  of  complicating  the  two  with 
each  other,  was  first  suggested  by  Fouchard.  When 
there  are  healthy  and  firmly  articulated  natural  teeth  re- 
maining in  the  upper  jaw,  such  substitutes  may  be  ad- 
vantageously connected,  but  the  mechanism,  as  intimated 
by  Delabarre,  would  be  too  heavy  to  be  sustained  by 
lateral  wings. 

"But  we  find,"  says  the  author  just  mentioned,  "in  vol. 
50,  page  386,  of  the  Journal  of  General  Medicine,  the 
description  of  a  dental  obturator,  presented  to  the  So- 
ciety of  Medicine,  by  M.  Touchard,  surgeon  dentist,  of 
Paris,  similar  to  the  one  he  had  applied  for  a  man  who 
had  lost  the  two  medial  incisores,  the  lateral  incisores, 
the  canine  and  the  first  bicuspis  of  the  right  side,  and  all 
the  part  of  the  maxillary  bone,  in  which  these  teeth  were 
situated,  as  wrell  as  a  portion  of  the  ascending  apophysis 
of  the  same  side,  and  finally  nearly  the  anterior  half  of 
the  bony  plate  which  forms  the  palatine  arch.  Notwith- 
standing the  loss  of  osseous  substance,  the  opening  which 


418   OBTURATORS  AND  PALATES  WITH  TEETH. 

formed  the  accidental  communication  between  the  nose 
and  the  mouth,  was  only  an  inch  in  diameter,  and  round. 
M.  Touchard  thought  that  in  perfecting  the  obturator 
described  by  M.  Fouchard,  he  might  apply  it  advan- 
tageously in  the  case  in  question.  Consequently,  he 
made  it  of  two  distinct  parts,  one  of  which  was  an  obtu- 
rator of  gold,  the  lower  side  concave,  and  the  upper  pre- 
sented a  round  elevation,  destined  to  be  inserted  in  the 
opening  of  the  palatine  arch.  The  other  was  a  piece  of 
hippopotamus,  to  which  he  gave  the  form  of  the  missing 
portion  destroyed  by  the  disease,  and  into  this  human 
teeth  were  inserted. 

The  obturator  and  teeth  were  firmly  united  by  means 
of  a  metallic  staff,  dove-tailed,  in  the  posterior  part  of  the 
latter.  Two  elastic  plates  of  gold  proceeding  from  the 
sides  of  the  instrument  and  pierced  with  holes,  passed 
behind  the  remaining  teeth  on  each,  and  by  their  ten- 
dency to  separate  from  one  another,  served  to  maintain 
the  apparatus  in  its  place.'5 

After  giving  the  foregoing  description,  M.  Delabarre 
remarks,  '-'the  learned  dentist  entrusted  with  the  report 
of  this  obturator,  has  judiciously  observed,  that  the  pro- 
longed action  of  the  elastic  plates,  would  result  in  the 
loosening  and  displacement  of  the  supporting  teeth.  Not 
only  am  I  of  this  opinion,  but  I  have  had  occasion  to  test 
that  machines,  however  wanting  in  elasticity,  always  ope- 
rated to  the  detriment  of  the  organs  against  which  they 
acted. " 

Again,  he  says,  "  M.  de  Chamant  has  engraved  in  his 
opusculi  on  mineral  paste  teeth,  a  dental  obturator,  which 
occupied  the  place  of  the  incisores,  the  coronoids  and  the 
four  bicuspides;  and  he  has  shown  me  another  mode 
after  the  same  plan,  and  supported  by  lateral  ligatures. 
We  perceive  all  the  advantage  resulting  from  the  employ- 


COMPLETE    PALATE    WITH    ARTIFICIAL    TEETH.   419 

nient  of  porcelain,  whenever  there  is  occasion  to  replace 
the  loss  of  substance  when  it  is  as  considerable  as  in  the 
case  just  mentioned.  Finally,  as  it  is  essential  to  take 
care  of  the  supports,  it  is  not  proper  to  make  use  of  the 
elastic  plates  advised  by  M.  Touchard,  nor  the  ligatures 
used  by  Fouchard  and  M.  de  Chemant,  but  the  elastic 
compressors  (clasps)  may  be  applied  with  more  advan- 
tage." 

When  the  loss  of  substance  is  very  great,  instead  of 
having  recourse  to  porcelain  block  teeth,  the  better  plan 
is,  to  make  a  raised  or  box  plate,  as  the  latter  would  be 
much  lighter,  and  as  a  matter  of  course  much  less  cum- 
bersome than  the  former.  The  plate  should  be  made  of 
twenty-one  or  two  carot  gold,  and  be  no  thicker  than  is 
absolutely  necessary.  Plate  XXX.  Figs.  3  and  4  rep- 
resents an  obturator  and  plate  complicated  with  artificial 
teeth. 

But  in  the  construction  of  a  dental  obturator,  the  den- 
tist will  always  have  to  be  governed  by  the  circumstances 
of  the  case,  and  therefore,  no  rules  can  be  laid  down  from 
which  it  will  not  be  necessary  occasionally  to  devaite. 
By  reference,  however,  to  the  illustrations  given  in  Plate 
XXX.  the  reader  will  be  able  to  obtain  such  general 
knowledge  of  the  subject,  as  will  enable  him  to  give  the 
proper  construction  to  the  mechanism  for  any  case  in 
which  his  aid  may  be  sought. 


OF  THE  CONSTRUCTION  OF  A  COMPLETE  PALATE  WITH  A  SET 
OF  ARTIFICIAL  TEETH. 

The  following  is  a  description  of  a  most  ingenious  con- 
trivance planned  by  M.  Delabarre  for  replacing  the  loss 
of  the  palate,  together  with  most  of  the  teeth  in  the  su- 


420    COMPLETE    PALATE    WITH    ARTIFICIAL    TEETH. 

perior  maxillary.  He  says  "the  most  serious  case  which 
can  be  presented  is  that  which  I  am  about  to  relate.  An 
individual  had  lost,  in  consequence  of  siphilis,  all  the 
bony  and  membranous  arch  of  the  mouth,  and  also  the 
greater  part  of  the  upper  teeth,  among  which  were  the 
lateral  ones,  which  would  have  been  the  most  favourable 
to  be  embraced  by  the  hooks,  (clasps.)  I  thought  of 
constructing  a  mineral  set  of  teeth,  surmounted  by  an 
arch  and  velum  of  platinum,  bearing  upon  sides  of  the 
cavities  a  circle  surrounding  the  parts  to  be  supplied. 
Inside  of  this  circle  was  encased  a  very  light  box, 
though  representing  the  thickness  and  figure  of  the  naso- 
palatine floor,  so  that  by  this  means,  I  restored  to  each  of 
the  cavities  the  form  it  had  before.  This  being  done,  I 
supported  the  obturator  by  springs  which  took  their  in- 
sertion upon  a  metallic  case  which  enclosed  the  lower 
dental  arch. 

The  machine  subserved  a  part  of  the  object;  that  is  to 
say,  the  nose  and  the  mouth  were  separated  by  it;  the 
patient  however  still  spoke  through  his  nose,  because  the 
soft  portion  of  the  palate  wTas  wanting.  It  was  then  ne- 
cessary to  replace  this.  I  could  have  constructed  a  cover 
and  a  movable  plate  in  metal,  as  the  goldsmith  Cadot,  of 
whom  Cullerier  speaks,  has  done.  But  I  preferred  gum 
elastic.  I  wished  to  employ  the  mechanism  of  degluti- 
tion for  my  purposes,  which  wrere  that  the  artificial  cover 
should  raise  and  fall  every  time  the  passage  of  food,  and 
even  that  of  saliva,  should  be  effected  from  the  mouth 
into  the  pharynx.  Consequently  the  tongue  became  the 
means  of  putting  the  mechanism  in  motion,  and  this  lat- 
ter was  disposed  of  to  this  effect,  in  the  following  manner. 

I  made  an  oval  window  in  the  fore  part  of  the  plate;  I 
then  placed  a  valve  which  clasped  itself  hermetrically  and 
which  was  held  in  place  by  means  of  an  axis  and  a  small 


ARTIFICIAL    PALATE    AND    NOSE.  421 

very  soft  spring.  To  this  plate  was  soldered  a  lever 
which  passing  backward,  rested  on  another  which  was 
held  in  a  see-saw  position  by  an  axis.  This  last  lever 
was  enough  to  reach  the  extremity  of  the  principal  plate, 
and  it  was  flattened,  so  as  to  fasten  to  the  movable  ve- 
lum, which  itself  was  attached  to  the  pharyngeal  border 
of  the  instrument. 

During  deglutition,  the  point  of  the  tongue,  applying 
itself,  pressed  upon  the  valve,  which  transmitted  to  all  the 
other  parts  the  movement  impressed  upon  it.  Thus  the 
velum  was  raised,  and  from  a  vertical,  assumed  nearly  a 
horizontal  position ;  in  such  a  way  that  neither  solid  food 
nor  drinks  could  escape  into  the  nasal,  cavities.  This 
plate,  complicated  with  the  artificial  teeth,  was  yet  by  no 
means  heavy,  for  the  plates  were  of  very  thin  platina, 
soldered  with  fine  gold.  The  patient  derived  great  ad- 
vantage from  it,  both  in  mastication  and  deglutition,  and 
in  the  articulation  of  words." 

It  is  possible  that  a  piece  of  mechanism,  such  as  the 
one  just  described,  might  be  made  to  answer,  to  some  ex- 
tent, the  purposes  for  which  that  was  designed,  but  hap- 
pily, cases  seldom  occur  which  call  for  so  complicated  an 
apparatus.  A  copy  of  the  engraving  which  the  author 
has  given  of  it  may  be  seen  in  Plate  XXX.  Fig.  6. 


Although  constituting  no  part  of  the  design  of  the  edi- 
tor, to  treat,  in  this  place,  of  the  prosthesis  of  any  other 
organs  than  the  palatine  and  maxillary,  he  will,  in  conclu- 
sion, subjoin  the  following  description  of  an  artificial  palate 
complicated  with  an  artificial  nose,  as  well  as  with  artificial 
teeth,  furnished  at  his  request,  by  his  brother  Dr.  John 
Harris,  formerly  of  Georgetown,  Ky,  The  subject  of 
54 


422  ARTIFICIAL    PALATE    AND    NOSE. 

which;  a  young  lady,  the  editor  had  an  opportunity  of 
seeing  about  twelve  months  since,  and  so  neatly  was  the 
mechanism  constructed  and  applied,  that  none  but  a  very 
close  and  critical  observer,  would  suspect  it  to  be  the  work 
of  art. 

Annapolis,  July  28,  1845. 

Dear  Brother, — Your  letter  of  this  morning  requesting 
me  to  send  you  by  return  of  mail  a  description  of  the  arti- 
ficial nose  and  palate  which  I  made  for  the  young  lady  of 
Scott  County,  Kentucky,  is  now  before  me,  but  received 
too  late  to  enable  me  to  comply  with  your  request,  but  I 
will  endeavour  to  do  so  by  the  next  succeeding  mail. 

I  very  much  regret,  from  the  novelty  and  importance  of 
the  case,  that  you  had  not  allowed  me  more  time,  but  I 
will  endeavour  to  do  the  best  I  can. 

The  subject  of  the  affliction  requiring  the  artificial  ap- 
purtenances referred  to,  is,  Miss  A.  C,  now  about  twenty 
years  of  age,  of  high  personal  and  family  respectability. 

When  but  little  past  infancy,  she  lost  her  nose  and  the 
central  portion  of  the  soft  and  bony  palate,  about  three- 
fourths  of  an  inch  in  length  and  three-eighths  in  width, 
commencing  about  five-eighths  of  an  inch  in  rear  of  the 
front  teeth  and  extending  backwards. 

I  have  no  knowledge  of  the  cause  that  led  to  the  af- 
fliction, only  that  it  was  preceded  by  inflammation, 
ulceration,  and  general  constitutional  derangement. 

When  about  twelve  years  of  age  she  submitted  herself  to 
be  operated  on  for  an  artificial  nose,  in  Cincinnati,  Ohio, 
by  Dr.  M.  The  design  of  which  was  to  supply  the 
defect  by  the  transfer  of  integument  from  the  arm,  over 
the  deltoid  muscle,  called  the  rhynoplastic  or  telecopeon 
operation. 

To  say  nothing  of  the  expense,  pain  and  suffering 
consequent  upon  the  operation,  and  the  jeopardy  her  life 


ARTIFICIAL    PALATE    AND    NOSE  423 

was  placed  in,  as  soon  as  her  health  would  admit,  she 
returned  to  her  home,  in  a  much  worse  condition  than 
when  she  left  it. 

To  add  to  her  misfortune,  before  she  left  the  city,  or 
had  fairly  recovered  from  the  effects  of  the  first  operation, 
mortified  with  her  now  aggravated  condition,  as  a  last 
alternative,  she  had  a  nose  manufactured  of  wood  by  a 
Mr.  Rostang,  resident  dentist  of  the  same  city,  and  con- 
fined in  its  position  by  means  of  spectacles,  and  an  artificial 
palate,  to  which  the  nose  was  connected  by  intermediate 
fixtures,  passing  through  the  palatine  fissure. 

As  might  have  been  expected,  the  subsequent  devel- 
opment of  the  maxilla  and  other  parts  soon  rendered  the 
whole  apparatus  useless,  though  not  until  it  had  destroyed 
the  three  teeth,  which  had  been  selected  as  a  support  to 
the  palate,  by  means  of  as  many  rough,  badly  constructed 
and  arranged  clasps. 

About  four  years  ago,  at  which  time  I  was  consulted  in 
her  case,  her  teeth  and  relative  parts  exhibited  the  fol- 
lowing appearance,  viz.  several  of  her  teeth  besides  the 
three  irrecoverably  injured  by  the  clasps,  were  more  or 
less  decayed:  some  of  which  quite  loose;  the  gums  and 
adjacent  soft  parts  much  inflamed,  tumefied  and  spongy, 
the  dental  arch  and  general  dimensions  of  the  mouth, 
(whatever  it  might  ever  have  been)  was  evidently  very 
much  collapsed  or  contracted,  say  to  nearly  one-half  of  the 
usual  size,  as  was  evidenced  by  the  position  of  the 
superior  cuspidati,  now  standing  parallel  to  each  other 
and  nearly  in  contact,  between  which  there  had  been  the 
usual  number  of  incisores  and  of  the  ordinary  dimensions, 
and  which  were  lost  when  she  was  about  ten  or  eleven 
years  of  age. 

Although  the  design  and  plan  of  the  apparatus  was  a 
good  one,  for  the   accomplishment  of  the   purpose   for 


424  ARTIFICIAL    PALATE    AND    NOSE. 

which  it  was  intended,  its  premature  application  was 
unquestionably  productive  of  the  worst  of  consequences, 
and  to  which  the  contraction  of  the  mouth  may  principally 
be  ascribed. 

Her  timidity  arising,  no  doubt,  from  the  recollection  of 
her  previous  suffering,  gave  me  no  little  trouble  in  obtain- 
ing her  consent,  to  the  course  of  practice  which  I  recom- 
mended, but  after  explaining  what  must  soon  be  her 
condition,  she  reluctantly  yielded  her  assent  and  permitted 
me  the  full  exercise  of  my  judgment  in  the  management 
of  her  case. 

The  removal  of  the  three  teeth  previously  referred  to, 
was  immediately  effected,  as  also  all  deposits  of  salivary 
calculus. 

In  about  eight  weeks,  with  the  usual  treatment,  the 
soft  parts  of  her  mouth  were  restored  to  health.  The 
local  maladies  of  her  teeth  were  next  attended  to,  and  in 
some  four  weeks,  thirteen  carious  places,  after  the  usual 
preparatory  treatment,  were  filled  with  gold  foil. 

With  the  mouth  thus  restored  to  health,  but  one  ques- 
tion could  arise  as  to  the  propriety  of  supplying  my 
patient  with  another  palate,  &c,  that  was,  if  the  max- 
illary organs  have  not  attained  their  full  development, 
the  same  destructive  consequences  might  be  produced, 
as  was  from  the  other  palate. 

From  the  circumstance  of  her  advanced  age,  I  did  not 
much  fear  this  would  be  the  case,  though,  had  I  been 
governed  entirely  by  my  own  inclination,  I  should  have 
deferred  all  further  proceedings  to  some  more  remote 
period,  but  in  this  I  was  overruled,  by  not  only  my  fair 
patient  herself,  but  by  all  her  family  connections,  and 
as  yet,  I  have  not  had  cause  to  regret  the  course  I  took. 

I  therefore  constructed  a  palate  of  fine  gold  upon  the 
usual  plan,  with  only  two  clasps,  made  broad  and  heavy, 


ARTIFICIAL    PALATE    AND    NOSE.  425 

one  on  the  left  and  one  on  the  right  margins  of  the  palate, 
embracing  two  of  the  soundest  and  most  suitable  teeth. 

To  the  convex  or  superior  surface  of  the  palate  one 
end  of  a  piece  of  gold  wire  three-fourths  of  an  inch  long, 
was  soldered  at  a  point  corresponding  with  the  fissure — 
from  front  to  rear,  and  on  a  line  extending  between  the 
two  teeth  embraced  by  the  clasps,  describing  the  centre  of 
action;  the  wire  or  upright  was  then  bent  forward  and 
upwards  so  as  to  pass  through  the  fissure  and  present  the 
upper  end  parallel  with,  and  at  a  convenient  distance 
from,  the  anterior  opening  of  the  naries, — this  place  of 
attachment  I  found  necessary,  that  no  unequal  or  undue 
pressure  might  result  from  the  weight  and  action  of  the 
superincumbent  parts  upon  the  palate. 

A  screw  was  now  cut  on  a  platina  wire,  for  one-half 
inch,  made  to  fit  in  a  corresponding  one,  made  through 
the  upper  end  of  the  upright  wire,  on  a  level  with  the 
external  opening  of  the  nose;  upon  the  other  or  anterior 
extremity  of  the  horizontal  platina  wire,  a  hook  or  catch 
was  made  as  a  support  to  the  nose  by  means  of  a  gold 
loop  attached  to  the  septum  of  the  artificial  nose,  the 
tightness  of  the  nose  to  be  regulated  by  screwing  the  hori- 
zontal wire  in  or  out,  and  its  position  by  bending  the  up- 
right backwards  or  forwards. 

The  length  of  the  horizontal  wire  is  one  inch,  the  size 
or  strength  needs  no  further  description. 

It  is  now  about  four  years  since  the  operation  was  com- 
pleted, and  thus  far,  I  have  heard  no  complaint. 
Yours,  affectionately, 

John  Harris. 

The  dentist,  although  seldom  called  upon  to  replace 
the  loss  of  the  nose  with  an  artificial  substitute,  yet  the 
manner  of  doing  it  should  be  understood  by  him.] 


EXPLANATION  OF  PLATES 


TO 


PART  THIRD. 


\ 


A 


PLATE   XXVIII 


FROM   SUBJECTS   FURNISHED   BY  THE  EDITOR. 

Fig.  1.  A  front  and  side  view  of  a  porcelain  tooth  with 
a  wood  pivot  or  tenon,  for  the  replacement  of 
the  crown  of  a  superior  central  incisor. 

Fig.  2.  A  front  view  of  a  porcelain  tooth  with  a  metallic 
pivot  for  the  replacement  of  the  crown  of  a 
superior  central  incisor,  with  a  representation 
of  the  pivot  before  it  is  fixed  in  the  tooth. 

Fig.  3.  A  wax  holder  made  of  tin  for  taking  an  impres- 
sion of  the  upper  jaw. 

Fig.  4.  A  wax  holder  for  taking  an  impression  of  the 
front  and  right  side  of  the  upper  jaw.  A  sim- 
ilar one  should  be  employed  for  taking  an 
impression  of  the  front  and  left  side. 

Fig.  5.  A  wax  holder  for  taking  an  impression  of  the 
lower  jaw. 

Fig.  6.  A  porcelain  substitute  for  the  left  central  incisor 
of  the  upper  jaw,  mounted  on  plate,  to  be 
clasped  to  the  first  molaris  of  same  side. 

Fig.  7.  A  porcelain  substitute  for  the  left  central  incisor 
of  the  upper  jaw,  mounted  on  plate,  to  be 
clasped  to  the  first  molaris  on  each  side. 


55 


\ 


PLATE   XXIX. 

FROM   SUBJECTS   FURNISHED   BY  THE   EDITOR. 

Fig.  1.  Porcelain  substitutes  for  the  two  central  incisores 
of  the  upper  jaw,  mounted  on  plate,  to  be 
clasped  to  the  second  bicuspides. 

Pig.  2.  Porcelain  substitutes  for  the  upper  incisores  and 
cuspidati,  mounted  on  plate,  to  be  clasped  to 
the  first  molares. 

Fig.  3.  Porcelain  substitutes  for  the  upper  incisores,  cus- 
pidati  and  the  left  bicuspides,  and  first  molaris, 
mounted  on  plate,  to  be  clasped  to  the  first 
bicuspis  and  first  molaris  on  the  right  side. 

Fig.  4.  Porcelain  substitutes  for  the  upper  incisores, 
cuspidati  and  bicuspides,  mounted  on  plate,  to 
be  clasped  to  the  first  molares. 

Ftg.  5.  Porcelain  substitutes  for  the  upper  incisores, 
cuspidati,  bicuspides  and  first  and  second  left 
molaris,  mounted  on  plate,  to  be  clasped  to 
the  first  right  molaris. 

Fig.  6.  Porcelain  substitutes  for  all  the  upper  teeth,  ex- 
cept the  dentes  sapientiae,  which  are  generally 
omitted  in  an  artificial  set,  mounted  on  plate, 
to  be  applied  upon  the  atmospheric  pressure 
and  suction  principle. 
Fig.  7.  Porcelain  substitutes  for  all  the  teeth  of  both 
jaws,  except  the  dentes  sapientiae,  which  are 
omitted,  mounted  on  plates  with  spiral  springs. 
Fig.  8.  A  spiral  spring,  with  its  attachments,  before  be- 
ing fixed  to  the  plates. 


PLATE   XXX. 

Figures  1,  2,  3,  and  4,  are  from  original  subjects,  fur- 
nished by  the  editor,  the  others  are  copied  from  Fouchard 
and  Delabarre. 

Fig.  1.  An  obturator,  for  an  opening  of  about  half  an 
inch  in  diameter  through  the  palatine  arch,  to 
be  clasped  to  the  first  molares. 
Fig.  2.  An  obturator  similar  to  the  last,  but  for  covering 

a  much  larger  opening. 
Fig.  3.  An  obturator  complicated  with  the  two  central 

incisores. 
Fig.  4.  An  obturator  complicated  with  the  incisores,  cus- 
piclati,  bicuspides,  and  the  first  and  second 
molares  of  the  left  side  of  the  mouth,  clasped 
to  the  dentes  sapientiae,  which  were  sound  and 
firmly  articulated.  The  original  of  this  was 
constructed  after  the  plan  adopted  by  Dr. 
Koecker,  for  restoring  a  similar  defect.  On 
the  left  side  of  the  mouth,  the  alveolar  border 
had  been  destroyed,  and  there  was  a  large 
opening  into  the  antrum  as  well  as  through 
the  roof  of  the  mouth. 
Fig.  5.  A  representation  of  an  obturator  constructed  by 
Delabarre  with  a  drum  on  its  upper  surface. 
Fig.  6.  A  representation  of  a  complete  palate,  writh  four- 
teen teeth,  constructed  by  M.  Delabarre. 


s 


432  PLATE    XXX. 

Fig.  7.  A  representation  of  a  palate  obturator  with 
the  uvula,  to  be  held  up  by  wings,  copied 
from  M.  Delabarre's  Mechanical  Dentistry, 
but  constructed  by  Cadet. 

Fig.  8.  Represents  an  obturator  constructed  by  M. 
Delabarre,  to  be  retained  in  the  mouth  by 
elastic  compressors.  This  instrument  is  an 
improvement  on  one  invented  by  Bourdet, 
which  was  held  up  by  means  of  ligatures 
applied  to  a  tooth  on  each  side  of  the 
mouth. 

Fig.  9.  Represents  a  winged  obturator,  invented  by 
Fouchard,  the  wings  turning  on  a  pivot. 
This  obturator  is  inserted  by  placing  one 
wing  above  the  other,  and  when  put  in 
place,  the  wings  are  turned  by  means  of  a 
key  in  opposite  directions,  which  prevents 
it  from  falling. 

Fig.  10.  Represents  another  winged  obturator  invented 
by  Fouchard  and  applied  by  means  of  a 
key.  It  is  held  in  its  place,  by  means  of  a 
piece  of  sponge  in  connection  with  the 
wings. 


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i 


INDEX. 


A. 

Abrasion  of  the  teeth,  mechanical,  252. 
Abscess,  alveolar,  remarks  on,  275. 

fomentations  to  cheek,  for  the  relief  of,  278. 
remarkable  cases  of,  282,  283. 
seldom  cured,  except  by  removal  of  tooth,  276. 
treatment  of,  extraction  when  the  gums  are  inflamed 

recommended,  277. 
when  produced  by  dentes  sapientiae  most  painful,  277. 
Abscesses,  formation  of,   105. 
Acids,  their  deleterious  effects  on  the  teeth,  300. 

used  in  analysis  of  the  teeth,  124. 
Adhesion  of  the  lips  and  cheeks  from  excessive  use  of  mercury,  312. 
Adjustment  and  adaptation  of  artificial  teeth  to  gold  plate,  388. 
Alveoli,  description  of,  286. 

absorption  of,  not  independent  of  local  irritation,  290. 
diseases  of,  288. 
growth  of,  30. 
Anatomists,  former  views  of,  on  the  destruction  of  temporary  roots,  73. 
Antrum  maxillary,  description  of,  317. 
diseases  of,  318. 
effects  of  diseased  teeth  on,  319. 
polypus  in,  and  cancerous  affections  of,  320. 
treatment  of,  322. 
Apparatus  for  grinding  artificial  teeth,  376. 
Arch,  palatine,  imperfections  of,  408. 
Arnold's  view  of  dental  germs,  47. 
Arteries,  dental,  59. 

distribution  of,  60. 
Atrophy  of  the  teeth,  58. 

B. 
Backings  for  artificial  teeth,  390. 

56 


\ 


434  INDEX. 

c. 

Calculus,  salivary,  description  of,  296. 

formation  of,  and  pathological  condition  of  the  general 

system,  favourable  to  its  production,  296. 
its  effects,  297. 

meaus  necessary  to  prevent  its  accumulation,  298,  299. 
Canal,  dental,  formation  of,  30. 

preparation  of,  for  reception  of  pivot,  374. 
Care  necessary  on  the  part  of  those  who  wear  artificial  teeth,  398. 
Caries,  dental,  arresting  progress  of,  in  temporary  teeth,   106. 

agency  of  diet  in  its  production,  considered,   168. 

constitutional  causes,  167. 

dependent  on  hereditary  predisposition,  170. 

first  manifestation  of,   158. 

frequently  caused  from  defective  formation  of  the  teeth 
only,  166. 

internal,  doctrines  of,  refuted,   165. 

of  permanent  teeth,  157. 

predisposing  causes  of,  166. 

prevention  of,  172. 

produced  by  pressure,  171. 

progress  of,  157. 

proximate  cause  of,  160. 

results  from  chemical  agents,   161. 

treatment  of,  176. 
Cementum  of  the  teeth,  and  formation  of,  56. 
Clasps  for  holding  artificial  teeth,  their  construction,  365. 
Climate,  its  influence  in  producing  caries  of  the  teeth,  considered,  169. 
Constitutional  effects  of  dentition,   112. 
Convulsions,  causes  of,  in  children,  113. 

Cooper's,  Mr.  Astley,  observations  on  vascularity  of  dental  pulps,  51. 
Crowns  of  teeth,  manner  of  excising,  371. 

D. 

Decay  of  temporary  teeth,  105. 

Dentes  sapientiae,  formation  of,  42. 

Dentifrices,  description  of,  for  the  prevention  of  tartar,  299. 

Dentition,  diseases  of,  108. 

erroneous  notions  of,  108. 

mechanism  of,  by  M.  Delabarre,  109. 

symptoms  of,  110. 
Diarrhcea,  causes  of,  in  children,  113. 

treatment  of,  1 14,  1 15. 


i 


INDEX.  435 

E. 

Effects  of  clasps  on  the  teeth  considered,  397. 
Enamel,  analysis  of,  125. 

removal  of,  by  denuding  process,  249. 
defective  formation  of,  57. 

formation,  hardness,  and  composition  of,  52,  53. 
Eruption,  cutaneous  from  dentition,  112. 

Excavating  caries,  its  importance,  and  the  difficulty  attending  it,  192. 
Excavators,  dental,  description  of,  191. 
Excrescences  of  the  gums,  removal  of,  by  ligatures,  268. 
Exostosis  of  the  teeth,  238. 

case  of,  242. 
probable  causes  of,  244. 
symptoms  of,  239. 
Experiments  with  chemical  agents,  their  effects  on  the  teeth,  162. 
Extraction  of  teeth,  remarks  on,  209. 

directions  for  those  of  the  incisores  and  cuspidati,  220. 
manner  of,  219. 

objects  of,  and  reasons  for,  210. 
of  bicuspides  and  molares,  222. 
of  roots  of  teeth,  229. 

F. 

Fangs  of  teeth,  formation  of,  39. 
ossification  of,  57. 
temporary,  absorption  of,  61,  67. 
Files  for  teeth,  best  shape  of,  &x.,  best  manner  of  using  them,  183. 
Filing,  its  bad  effects  in  the  regulation  of  teeth,  171. 
custom  of  savage  nations  in  relation  to,  180. 
for  removal  of  caries,  highly  beneficial,  171. 
manner  of,  in  order  to  prevent  reapproximation  of  teeth,  182. 
root  of  tooth  for  the  reception  of  artificial  crown,  374. 
Foil  for  filling  teeth,  proper  manner  of  introducing  it  into,   194. 
Fomentations  to  face,  when  necessary,  278. 
Forceps  for  extraction  of  teeth,  remarks  on  their  superiority,  214. 

for  extraction  of  bicuspides  of  both  jaws,  inferior  cuspidati,  and 

inferior  dentes  sapientiae,  217. 
for  inferior  incisores,  218. 
for  inferior  molares,  218. 
for  superior  dentes  sapientiae,  217. 
for  superior  incisores  and  cuspidati,  215. 
for  superior  molares,  216. 


\ 


436  INDEX. 

Forceps,  number  requisite,  215. 

their  formation  described,  215,  218. 
compound  root,  description  of,  231. 

G. 

Goodsir's  views  of  the  formation  of  dental  germs,  47. 
Gumboils,  produced  by  decayed  stumps,   174. 

influence  on  the  general  health,  174. 
Gums,  diseases  of,  260. 

preternatural  growth  of,  and  treatment,  265,  266. 

lancing  of,  in  difficult  dentition,   118. 

H. 

Hemorrhage  after  extraction  of  teeth,  237. 

mode  of  arresting  it,  237. 
Hunter's,  John,  views  on  structure  of  the  teeth,  62. 

I. 

Impressions  of  the  mouth,  how  taken,  354,  381. 

Incisores,  ossification  of,  50. 

Inflammation  of  membrane  in  nervous  cavity,  162. 

Instruments  for  extraction  of  roots  of  teeth,  directions  for  the  use  of  the 

elevator,  hook  and  screw,  230. 
Irregularity  of  teeth,  the  treatments  necessary  to  remedy,  87,  93. 

caused  by  cuspidati,  93. 

construction  of  appliances  for  the  remedying  of,  88. 

four  states  of,  95. 

time  most  suitable  for  its  correction,  96. 

varieties  of,  88. 
Irritation,  consequent  upon  dentition,   111. 

J. 

Jaw-bone,  exfoliation  of,  caused  by  diseased  tooth,  280. 

exfoliation  of,  caused  by  use  of  mercury  and  by  small-pox,  312. 
articulation  of,  326. 

its  movements  resembling  that,  both  of  the  graminivorous  and 
carnivorous  animals,  326. 
Jaw,  inferior,  alveoli  of,  more  liable  to  absorption  than  superior,  292. 

its  motion  produced  by  five  pair  of  muscles,  327. 
Jaws,  mal-conformation  of,  77. 
accretion  of,  78. 
diversity  of  opinion  concerning  their  increase,  81. 


INDEX.  437 

K. 

Key  instrument,  remarks  on,  210. 

directions  for  the  use  of,  233. 

L. 

Lancing  the  gums,  beneiits  of,  in  dentition,  118. 

Lancet,  gum,  description  of,  and  the  parts  necessary  to  be  lanced,  120. 

Luxation  of  lower  jaw,  reduction  of,  325. 

how  produced,  and  liability  of  its  recurrence,  328. 

manner  of  relieving,  various  means  spoken  of,  330. 

prevention  of,  331. 

M. 

Matrix,  dental,  transformation  of,  69. 
Maxilla,  foetal,  development  of,  29. 
Membrane,  dental,  preformative,  56. 

destruction  of,  58. 
Membranes,  dental,  vascularity  of,  45. 
Mercury,  its  effects  on  the  teeth,  309. 

deleterious,  and  fatal  effects  of,  as  exhibited  in  the  case  of  a 

patient  in  Guy's  Hospital,  311. 
its  influence  on  the  gums ;  renders  them  more  susceptible  to 

future  morbid  affections,  316. 
produces  no  direct  effect  on  the  teeth,  315. 
symptoms  of  its  presence ;    manifested  by  looseness  of  teeth 
and  soreness  of  the  gums,  309. 
Models,  metallic,  how  obtained,  and  metals  necessary  for,  382,  383. 

antagonizing,  how  obtained,  388,  399. 
Molares,  first,  their  liability  to  decay,  94. 

permanent,  anterior,  formation  of,  41. 
ossification  of,  41,  51. 
Mouth,   its    healthy    condition    necessary    for    reception    of    artificial 
teeth,  369. 

N. 
Nasal  and  palatine  apparatus,  constructed  by  Dr.  John  Harris,  422,  425. 
Necrosis,  dental,  remarks  on,  245. 
causes  of,  246. 

confined  particularly  to  the  front  teeth,  245. 
treatment  in  the  early  stages  of,  246. 
Nerves,  dental,  distribution  of,  60. 

method  of  destroying,  207,  208,  373. 


438  INDEX. 

o. 

Obturators,  artificial,  408. 

complicated  with  artificial  teeth,  417,  418. 
construction  of,  their  former  imperfection  and  con- 
sequences, 412 — 415. 
improvements  on,  by  M.  Delabarre,  416. 

P. 

Paces,  its  use  in  the  extraction  of  teeth,  212. 
Palates,  artificial,  408. 

with  sets  of  artificial  teeth,  419. 
Peduncle  of  dental  sac,  observations  on,   109. 
Perpendicular  extractor,  213, 

Phthisis  pulmonalis,  indicated  by  transparency  of  the  teeeth,   174. 
Pivoting  method  of  inserting  artificial  teeth,  manner  of,  356. 
Pivot  teeth,  mannner  of  inserting,  370. 

Pivots,  suitable  materials  for,  and  manner  of  preparing  them,  377. 
tubed,  for  escape  of  pus,  with  holes  in  artificial  crown,  379. 
with  gold  in  centre,  378. 
with  groove  on  side  for  egress  of  matter,  379. 
Plate,  gold,  for  artificial  teeth,  its  thickness  and  purity,  365. 

box,  recommended,  in  some  cases,  388. 
confined  by  atmospheric  pressure,  366. 
manner  of  stamping,  fitting  and  attaching 
clasps  to,  384. 
Plates,  construction  of,  in  particular  cases,  404 — 407. 
Plugging  the  teeth,  when  indicated,  186. 

as  recommended  in  case  of  exposed  nerve,  188. 
in  such  way  as  to  admit  the  escape  of  pus,  188. 
so  as  to  prevent  pressure  on  exposed  nerve,  188. 
suitable  instrument  for,  191,  194. 
the  difficulties  of,  193. 
the  proper  material  for,  189. 
when  improper,  187. 
Porcelain,  its  use  in  the  manufacture  of  teeth,  359. 
Processes,  alveolar,  description  of,  286. 

absorption  of,  not  independent  of  local  irritation,  290. 
diseases  of,  288  293. 
Pulps,  dental,  first  appearance  of,  30. 
elongation  of,  52. 
union  of,  59. 
vascularity  of,  44 — 51. 


i 


INDEX.  439 

Processes,  alveolar,  rudiments  of,  29. 
Punch  for  the  removal  of  roots  of  teeth,  212. 
Pustules,  formation  of,  during  dentition,  113. 

R. 

Raschow  and  others,  researches  of,  on  the  formation  of  the  teeth,  54. 
Roots  of  teeth,  temporary,  destruction  of,  72. 

manner  of  attaching  an  artificial  crown  to,  376. 

manner  of  preparation  of,  for  artificial  teeth,  371. 

temporary,  non-absorption  of,  68. 

the   condition   necessary  for   the  reception  of  artificial 
crowns,  363. 

S. 
Sacs,  dental,  their  appearance  when  given  off,  45. 
Scaling  the  teeth,  manner  of  applying  the  instruments,  306. 

description  of  instruments  necessary  for  its  performance,  307. 
Scrofulous  habits  in  children,  and  their  consequent  liability  to  tumours 

and  excrescences  of  the  gums,  272. 
Scurvy  of  the  gums,  261. 

how  marked,  261. 

treatment  of,  in  the  more  advanced  stages,  263. 
treatment  of,  in  the  incipient  stages,  262. 
Sockets  of  teeth,  inflammation  of,  indolent  kind,  282. 

formation  of,  41. 
Soldering  teeth  to  plate,  preparation  for  and  manner  of,  391. 

apparatus  necessary  for,  392. 
Spina  Ventosa,  confined  to  the  incisores  and  cuspidati  of  upper  jaw,  247. 

what  it  consists  of,  its  effects  and  treatment,  248. 
Springs,  spiral,  when  used,  365. 
Stumps  of  teeth,  generally  cause  inflammation,  160. 
Substance,  granular,  transformation  of,  54. 

carneous,  remarks  on,  70. 
Substitutes,  dental,  temporary,  369. 
Symptoms  of  dentition,  111. 

T. 
Teeth,  temporary,  ossification,  number  and  division  of,  31. 
articulation  of,  39. 
composition  of,  50. 
description  of,  36. 
discoloration  of,  64. 
eruption  and  completion  of,  32,  33,  34. 


s 


440  INDEX. 

Teeth,  fractures  of,  and  treatment  for,  2-54. 
human,  analysis  of,  123. 
irregularity  of,  causes  of,  76,  78. 
irregularity  of,  prevention  of,  83. 
most  suitable  for  the  attachment  of  clasps,  395. 
permanent,  formation  of,  35. 
permanent,  irregularity  of,  76. 
supernumerary,  103. 

temporary,  importance  of  their  removal  at  a  proper  time,  82. 
temporary,  shedding  of,  66,  74. 
temporary,  shedding  of,  time  required  for,  84,  86. 
temporary,  time  and  manner  of  replacement,  74. 
artificial,  arrangement  of,  and  how  antagonized,  400. 
demand  for,  357. 

great  improvement  in  their  manufacture,  353. 
insertion  of,  3(32. 

insertion  of,  on  plate,  and  secured  by  clasps,  364. 
manner  of  confinement  in  the  mouth,  355. 
Tic  douloureux,  description  of,  202. 

case  of,  recorded  by  Dr.  Haighton,  202,  203. 
Tooth-ache,  arising  from  sympathetic  affections  of  gums  or  sockets,  204. 
remarks  on,   197,  198. 
its  frequent  results,  202. 
remedies  for,  201. 
treatment  of,  199,  200. 
Tooth,  carious,  removal  of  sensitiveness  for  purpose  of  filling,  205. 
Transplanting  teeth,  former  practice  of,  356. 

immoral  tendency,  and  baneful  effects  of,  357. 
Treatment  of  first  dentition,   104. 
Trismus  produced  by  dentition  of  molar  teeth,  122. 
Tube,  gold,  for  pivoting  when  it  is  necessary,  375. 
Tubercle,  carneous,  proofs  of,  70. 
first  appearance  of,  71. 

V. 

Vaccination,  its  importance,  and  happy  influence  in    the  prevention  of 

small-pox,  314,  315. 
Vascularity  of  the  teeth,  63. 

W. 
Wax-holder,  description  of,  382. 

THE     END. 


i 


THEOLOGICAL 


AND 


PUBLISHE  D    BY 


BARMNGTON  AND  HASWELL, 


I 


AN  EXPOSITION 


OF   THE 


JLD  AM  D>  NEW  TEST^MEMl9, 


m 


Wherein  each  chapter  is  summed  up  in  its  contents;  the  sacred  text  inserted  at  large,  in 

distinct  paragraphs  ;  each  passage  reduced  to  its  proper  heads ;  the 

sense  given,  and  largely  illustrated. 

WITH  PRACTICAL   REMARKS    AND  OBSERVATIONS, 

BY  MATTHEW  HENRY. 

Edited  by  the  Rev.  Geo.  Burder,  and  the  Rev.  Joseph  Hughes,  A.m. ;  with  the  Life  of  the 
Author,  by  the  Rev.  Samuel  Palmer. 

TO    WHICH    IS    PREFIXED    A    PREFACE, 

BY  ARCHIBALD  ALEXANDER,  D.D., 

PROFESSOR   OF    THEOLOGY    IN    THE    SEMINARY    AT    PRINCETON,    NEW    JERSEY. 

First  American  Edition,  6  vols,  super  royal  8vo. 

This  work  has  elicited  so  decidedly  the  approbation  of  the  most  judicious  men  of  the  prin- 
cipal denominations  of  Christians  in  the  United  States,  that  the  Publishers  deem  it  unnecessary 
to  offer  now  many  of  the  numerous  recommendations  they  have  received  from  various- 
quarters. 

The  following  will  serve  to  show  the  universal  opinion  in  regard  to  this  work : 

From  the  Rev.  S.  H.  Cone,  Pastor  of  the  Oliver  Street  Baptist  Church,  N.  York- 

"I  have  examined  the  stereotype  edition  of  Matthew  Henry's  Exposition  of  the  Old  and 
New  Testament,  and  take  pleasure  in  bearing  testimony  to  its  typographical  neatness  and 
accuracy,  and  the  comparative  cheapness  of  price  at  which  it  is  now  offered  to  the  American 
public. 

"  With  reference  to  the  intrinsic  excellence  of  the  work  itself,  it  needs  not  my  feeble  com- 
mendation. The  wise  and  good  unite  in  saying,  that  it  is  calculated  to  render  those  who  read 
it  wiser  and  better ;  and  having  frequently  derived  from  it  edification  and  comfort  myself,  I  do 
sincerely  hope  you  may  succeed  in  circulating  it  extensively  among  my  fellow-citizens." 


§83= — : ~~~~— 

y        The  following  vivid  delineation  of  its  characteristic  qualities  is  from  the  pen  of  the  Rev. 
Dr.  Alexander,  of  Princeton: 

"A  characteristic  of  this  Exposition  of  a  more  important  kind  than  any  that  have  been 
mentioned,  is  the  fertility  and  variety  of  good  sentiment  manifest  throughout  the  work.     The 
mind  of  the  author  seems  not  only  to  have  been  imbued  with  excellent  spiritual  ideas,  but  to 
have  teemed  with  them.     It  is  comparable  to  a  perennial  fountain,  which  continually  sends  forth 
streams  of  living  water.     In  deriving  rich  instruction  and  consolation  from  the  sacred  oracles, 
adapted  to  all  the  various  conditions  and  characters  of  men,  the  author  displays  a  fecundity  of 
thought,  and  an  ingenuity  in  making  the  application  of  divine  truth,  which  strikes  us  with 
admiration.     The  resources  of  most  men  would  have  been  exhausted  in  expounding  a  few 
books  of  the  Bible ;  after  which  little  more  could  have  been  expected  than  common-place 
matter,  or  a  continual  recurrence  of  the  same  ideas ;  but  the  riches  of  our  Expositor's  mind 
seem  to  have  been  inexhaustible.     He  comes  to  every  successive  portion  of  the  sacred  Scrip- 
tures with  a  fulness  and  freshness  of  matter,  and  with  a  variety  in  his  remarks,  which,  while 
;    it  instructs,  at  the  same  time  refreshes  us.     Even  in  his  Exposition  of  those  books  which 
.    are  very  similar  in  their  contents,  as  the  gospels  for  example,  we  still  find  a  pleasing  variety 
:    in  the  notes  of  the  commentator.     It  is  difficult  to  conceive  how  one  man  should  have  been 
;    able  to  accomplish  such  a  work,  without  any  falling  off  in  the  style  of  execution." 

The  Rev.  Edward  Bickersteth  says, — "  There  is  in  Matthew  Henry  a  glow  of  love,  a  full 
:'  exhibition  of  the  sense,  a  happy  reference  to  the  passage  expounded,  and  a  livery  cheerfulness, 
'    which  will  ever  make  his  work  popular,  useful,  and  indispensable." 

Dr.  Doddridge  says, — "  Henry  is,  perhaps,  the  only  commentator  so  large  that  deserves  to 
be  entirely  and  attentively  read  through.  The  remarkable  passages,  I  think,  should  be  re- 
marked. There  is  much  to  be  learned  from  this  work  in  a  speculative,  and  still  more  in  a 
practical  way." 

Dr.  Edward  Williams  says, — "  It  is  an  incomparable  work,  and  too  well  known  to  need  a 
discriminating  character." 

The  Rev.  Thomas  Hartwell  Home,  in  his  valuable  Introduction  to  the  Study  of  the  Scrip- 
tures, says,  that  "  its  high  and  generally  known  value  is  so  just  and  extensive,  that  it  needs  no 
recommendation." 

The  Rev.  Adam  Clarke,  the  Commentator,  says, — "The  Rev.  Matthew  Henry,  a  very 
eminent  dissenting  minister,  is  author  of  a  very  extensive  Commentary  on  the  Old  and  New 
Testaments,  and  one  of  the  most  popular  works  of  the  kind  ever  published.  It  is  always 
orthodox,  generally  judicious,  and  truly  pious  and  practical." 

Extract  of  a  letter  from  the  Rev.  Francis  Wayland,  President  of  Brown  University. 
"  I  am  gratified  to  hear  of  your  intention  to  present  the  religious  public  with  an  American 
edition  of  Henry's  Commentary.     I  know  of  no  work  of  the  kind  in  any  language  which 
combines  more  sound  good  sense  with  fervent  and  deep-toned  piety." 


THE  NEW  TESTAMENT 

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THE     NEW    TESTAMENT, 


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